THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
 

PUBLIC HEALTH SERVICE
 

CENTERS FOR DISEASE CONTROL AND PREVENTION
 

NATIONAL INSTITUTE FOR OCCUPATIONAL SAFETY AND HEALTH
 

convenes the
 

ADVISORY BOARD ON
 

RADIATION AND WORKER HEALTH
 

The verbatim transcript of the Meeting of the
 

Advisory Board on Radiation and Worker Health held
 

via Teleconference on Thursday, August 22, 2002.
 

NANCY LEE & ASSOCIATES 

Certified Verbatim Reporters
 

P. O. Box 451196
 

Atlanta, Georgia 31145-9196
 

(404) 315-8305
 
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C O N T E N T S
 

PARTICIPANTS (by group, in alphabetical order) ..... 3 
 

ROLL CALL AND INTRODUCTIONS
 

Dr. Ziemer/Ms. Homer ................. 5 
 

CALL TO ORDER
 

Dr. Ziemer ...................... 10 
 

LETTER TO HHS REGARDING MEMORANDUM OF UNDERSTANDING 

AND RETENTION OF RECORDS
 

Dr. Ziemer ...................... 15 
 

Board Comments .................... 18 
 

Public Comments ................... 22 
 

Vote ........................ 33 
 

LETTER TO HHS REGARDING 42 CFR PART 83 COMMENTS AND
 

RECOMMENDATIONS
 

Dr. Ziemer ...................... 34 
 

Board Comments .................... 36 
 

ATTACHMENT 1
 

Motion/Vote .................. 53/58
 

Motion/Vote .................. 69/71
 

Motion/Vote ................... 74/74
 

Dr. Ziemer ...................... 39 
 

Non-SEC Listed Cancers ................ 39 
 

Health Endangerment ................. 41 
 

Dose Reconstruction Guidelines ............ 60 
 

Interim Final Rule .................. 65 
 

ATTACHMENT 2
 

Dr. Ziemer ...................... 75 
 

Section 83.1 ..................... 77 
 

Section 83.2 ..................... 78 
 

Motion/Vote .................. 89/89
 

Section 83.5 ..................... 91 
 

Section 83.9 ..................... 76 
 

Section 83.10 .................... 92 
 

Section 83.13 .................... 95 
 

Motion/Vote ................. 96/96, 100
 

ADJOURN ....................... 100 
 
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CERTIFICATE OF REPORTER . . . . . . . . . . . . . . . . 101 
 
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P A R T I C I P A N T S
 

(By Group, in Alphabetical Order)
 

ADVISORY BOARD MEMBERS
 

CHAIR
 

PAUL L. ZIEMER, Ph.D. 

Professor Emeritus
 

School of Health Sciences
 

Purdue University
 

Lafayette, Indiana
 

EXECUTIVE SECRETARY
 

LARRY J. ELLIOTT
 

Director, Office of Compensation Analysis and Support
 

National Institute for Occupational Safety and Health
 

Centers for Disease Control & Prevention
 

Cincinnati, Ohio
 

MEMBERSHIP
 

HENRY A. ANDERSON, M.D.
 

Chief Medical Officer
 

Occupational and Environmental Health
 

Wisconsin Division of Public Health
 

Madison, Wisconsin
 

ANTONIO ANDRADE, Ph.D.
 

Group Leader, Radiation Protection Services Group
 

Los Alamos National Laboratory
 

Los Alamos, New Mexico
 

ROY LYNCH DeHART, M.D., M.P.H.
 

Director
 

The Vanderbilt Center for Occupational and Environmental
 

Medicine
 

Professor of Medicine
 

Nashville, Tennessee
 

RICHARD LEE ESPINOSA
 

Sheet Metal Workers Union Local #49
 

Johnson Controls
 

Los Alamos National Laboratory
 
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Espanola, New Mexico
 

SALLY L. GADOLA, M.S., R.N., COHN-S
 

Occupational Health Nurse Specialist
 

Oak Ridge Associated Universities
 

Occupational Health
 

Oak Ridge, Tennessee
 

MARK A. GRIFFON
 

President
 

Creative Pollution Solutions, Inc.
 

Salem, New Hampshire
 

JAMES M. MELIUS, M.D., Ph.D.
 

Director
 

New York State Laborors’ Health and Safety Trust Fund
 

Albany, New York
 

WANDA I. MUNN
 

Senior Nuclear Engineer (Retired)
 

Richland, Washington
 

ROBERT W. PRESLEY
 

Special Projects Engineer
 

BWXT Y-12 National Security Complex
 

Clinton, Tennessee
 

NIOSH STAFF/VENDORS
 

CORRINE HOMER
 

LIZ HOMOKI-TITUS
 

TED KATZ
 

MARIE MURRAY, Writer/Editor
 

DAVID NAIMON
 

KIM NEWSOM, Certified Court Reporter
 

AUDIENCE PARTICIPANTS
 

VINA COLLEY FRANK MORALES
 

KEN CRASE LEON OWENS
 

JOY GEST MARK REINHALTER
 

MIKE GIBSON ROBERT TABOR
 

RICHARD MILLER JERRY TUDOR
 
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P R O C E E D I N G S
 

1:00 p.m.
 

DR. ZIEMER: I got a memo from Dr. Roessler. 

She’s not going to be on the conference call. 

She did e-mail her comments.
 

Tony Andrade is here?
 

DR. ANDRADE: Right.
 

DR. ZIEMER: Henry Anderson?
 

MS. HOMER: Okay. 

DR. ZIEMER: Is Henry here?
 

MS. NEWSOM: I have not heard from Henry yet.
 

MS. HOMER: Okay. 

DR. ZIEMER: Is Jim Melius?
 

MS. MUNN: Haven’t heard him.
 

DR. ZIEMER: Larry Elliott?
 

MR. ELLIOTT: Here.
 

DR. ZIEMER: Mark Griffon?
 

MR. GRIFFON: Yes.
 

DR. ZIEMER: Rich Espinosa?
 

MS. HOMER: Um-hum (affirmative).
 

DR. ZIEMER: Bob Presley? 

MR. PRESLEY: Here. 

DR. ZIEMER: Roy DeHart? 

DR. DeHART: Yes. 

DR. ZIEMER: Has Sally come aboard yet? 

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MS. GADOLA: I’m here. 

DR. ZIEMER: Okay, Sally’s here. 

And Wanda? 

MS. MUNN: Um-hum (affirmative).
 

DR. ZIEMER: Okay. 

MS. HOMER: So we’re only missing Dr.
 

Anderson.
 

DR. ZIEMER: We’re missing Anderson and –
 

UNIDENTIFIED: Jim Melius.
 

DR. ZIEMER: Melius, yeah.
 

UNIDENTIFIED: And Gen, you said Gen wasn’t
 

going to be –
 

DR. ZIEMER: Gen Roessler will not be on this
 

conference call, it turned out.
 

DR. MELIUS: Hi, it’s Jim Melius.
 

DR. ZIEMER: Oh, Jim’s here. Okay. Hi, Jim.
 

Jim, we’re waiting for Henry Anderson, I
 

think. Gen Roessler is not going to be on the
 

conference call. All the other board members
 

except Henry are with us now.
 

And then we have some members of the public. 

I know that Bob Tabor’s aboard. Right, Bob?
 

MR. TABOR: Yes, I’m here.
 

DR. ZIEMER: And who else?
 

MR. MILLER: Richard Miller’s here.
 

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DR. ZIEMER: Richard’s here. Hello, Richard. 

MR. MILLER: Hi, Paul. 

DR. ZIEMER: Any other members of the public? 

MR. CRASE: Ken Crase. 

DR. ZIEMER: Ken. 

MS. GEST: Gest from Hanford.
 

MR. NAIMON: David Naimon and Liz Homoki-Titus
 

from the Department of Health and Human Services. 

DR. ZIEMER: Thank you. 

MR. REINHALTER: Mark Reinhalter from the
 

Department of Labor.
 

DR. ZIEMER: Thank you. 

UNIDENTIFIED: I’m sorry, we didn’t catch the
 

name from Hanford.
 

MS. GEST: Joy Gest, G-E-S-T.
 

UNIDENTIFIED: Thank you.
 

DR. ZIEMER: And we’ve got Richard Miller. 

just want to make sure the recorder got all the –
 

MS. NEWSOM: I believe I’ve got everybody
 

that’s come in so far.
 

MR. GIBSON: Mike Gibson’s here too.
 

UNIDENTIFIED: Hi, Mike.
 

MR. GIBSON: Hi.
 

MR. OWENS: Leon Owens.
 

UNIDENTIFIED: And Leon Owens is here also.
 

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DR. ZIEMER: Leon is on.
 

MR. KATZ: Ted Katz from Atlanta. 

DR. ZIEMER: Any others?
 

MR. KATZ: Did you catch me? Ted Katz from
 

Atlanta. 

MS. HOMER: Um-hum (affirmative). 

UNIDENTIFIED: Hi, Ted.
 

MR. KATZ: Hi.
 

MR. TUDOR: Jerry Tudor from Oak Ridge.
 

DR. ZIEMER: Okay.
 

MS. MURRAY: I’m sorry, what was that name?
 

DR. ZIEMER: Jerry –
 

MR. TUDOR: Tudor, T-U-D-O-R.
 

MS. MURRAY: Thank you. 

DR. ZIEMER: Okay. Let me see. We have, as
 

far as the voting members of the Committee, we
 

have one, two, three, four, five, six, seven,
 

eight, nine – we have ten voting members on board
 

right now, is that correct? 

UNIDENTIFIED: Yes.
 

MR. ELLIOTT: Yes, I believe so.
 

MS. HOMER: Seven, eight, nine.
 

MS. MUNN: I have nine.
 

MS. HOMER: Nine.
 

MR. ELLIOTT: The only one we were missing is
 

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Henry Anderson.
 

UNIDENTIFIED: And Gen Roessler.
 

UNIDENTIFIED: Gen Roessler, yes, okay. 

DR. ZIEMER: Did somebody just come aboard?
 

MS. COLLEY: Hi. This is Vina Colley from
 

the Portsmouth Gaseous Diffusion Uranium
 

Enrichment facility in Piketon, Ohio.
 

DR. ZIEMER: Thank you. Did you get the
 

name, the recorder?
 

MS. NEWSOM: Could you repeat that, please? 

DR. ZIEMER: Lani?
 

UNIDENTIFIED: Background. 

MS. MUNN: A lot of background. 

UNIDENTIFIED: Last call got a lot of 

background noise. 

UNIDENTIFIED: Vina Colley. 

DR. ZIEMER: Zina?
 

MS. COLLEY: Vina, V-I-N-A, Colley.
 

DR. ZIEMER: Vina, okay. Got it.
 

MS. COLLEY: I’m having – probably going to
 

be pretty noisy, but what I’d like to say is that
 

I want to see meetings around the Portsmouth
 

Gaseous Diffusion Plant like the rest of these
 

plants are having meetings. 

DR. ZIEMER: Yeah, can you hold that, because
 

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we haven’t started yet. We’re waiting for
 

everybody to get aboard.
 

DR. ANDERSON: Hi, it’s Andy. I just signed
 

on.
 

UNIDENTIFIED: Okay, good. There we go.
 

DR. ZIEMER: Anderson?
 

DR. ANDERSON: Yes.
 

DR. ZIEMER: Yes, okay. So I think we have
 

everybody now, so let me call the meeting
 

officially to order.
 

I’m hearing a lot of background noise. Can
 

everybody here me all right?
 

UNIDENTIFIED: I can’t hear you over that,
 

sorry.
 

UNIDENTIFIED: (inaudible) on that cellular
 

(inaudible) going to have to go on mute
 

(inaudible) contributing to the background noise.
 

DR. ZIEMER: Is that better?
 

UNIDENTIFIED: That’s better.
 

DR. ZIEMER: Okay. I’m officially calling
 

the meeting to order. 

We have our agenda today. We’ll have really
 

two things. We will have opportunity for public
 

input, and then we have two documents to review
 

and act on. One is – let me ask first, did
 

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everybody get copies of the two documents? 

UNIDENTIFIED: No. 

DR. ANDERSON: Yes, I did. 

UNIDENTIFIED: (inaudible) 

DR. ZIEMER: I’m sorry?
 

MR. MILLER: At least folks who are not on
 

the board, I didn’t get one. Richard Miller.
 

DR. ZIEMER: Okay. Let’s see, Cori, is there
 

a way to transmit those documents by e-mail to
 

those folks?
 

MS. HOMER: If I can get the e-mail addresses
 

I can forward them. I’ve got Richard Miller’s.
 

MR. MILLER: That’d be great, Cori. I would
 

appreciate that. 

MS. MUNN: I’m still getting an awful lot of
 

background noise (inaudible) –
 

UNIDENTIFIED: Excuse me, I came in late. 

Can we identify everyone who’s on the call?
 

DR. ZIEMER: Sorry?
 

UNIDENTIFIED: I came in on this. Could we
 

identify everyone that’s on the call?
 

DR. ZIEMER: Sure. Maybe we could ask our
 

recorder to – can you easily go through the
 

names?
 

MS. MURRAY: Yeah. (inaudible), Mark
 

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Griffon, Wanda Munn, Bob Presley, (inaudible) –
 

MR. ELLIOTT: I’m sorry. This is Larry
 

Elliott. I would ask that everybody that has a
 

mute button on their phone use it, except for of
 

course when they’re speaking. Maybe that will
 

cut out the background noise. If that doesn’t
 

cut out the background noise, we’re going to have
 

to identify that individual and they’re going to
 

have to get on a different phone because the
 

recorder can’t hear everybody, and everybody else
 

on the phone can’t hear.
 

MR. TABOR: Larry, Bob Tabor here. It sounds
 

to me like everything was pretty clear, except if
 

you’ve got somebody on cellular that might be in
 

an automobile they’re going to pick up all that
 

road noise.
 

DR. ZIEMER: Is anybody on a cellular in an
 

automobile?
 

MR. ESPINOSA: Actually, I – this is Rich
 

Espinosa.
 

DR. ZIEMER: Are you moving, Rich, or just –
 

MR. ESPINOSA: No, I’m just going to park
 

right now.
 

DR. ZIEMER: Yeah, that would be probably
 

good.
 

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MR. ESPINOSA: Okay. 

DR. ZIEMER: Anyone else?
 

[No responses] 

DR. ZIEMER: Okay. Can you go through the 

names again? 

MS. MURRAY: Okay. Board members: Wanda 

Munn, Bob Presley, Roy DeHart, Sally Gadola, Paul
 

Ziemer, Tony Andrade, Richard Espinosa, Jim
 

Melius, and Henry Anderson. From NIOSH, Larry
 

Elliott, Cori Homer, and Ted Katz. Members of
 

the public: Mike Gibson, Vina Colley, Jerry
 

Tudor, Richard Miller – I’m sorry, for DHHS I
 

should add David Naimon and Liz Homoki-Titus. 

Other members of the public: Mark Reinhalter,
 

Joy Gest, Ken Crase, Gibson – I’ve got you
 

already – and Leon Owens. Did I miss anybody? 

MR. TABOR: I don’t know. Did you say Bob
 

Tabor?
 

MS. MURRAY: I did.
 

MR. TABOR: Okay, thank you. 

MR. MORALES: Also Frank Morales.
 

MS. MURRAY: Frank Morales, thank you. 

MR. REINHALTER: And I would just – Mark
 

Reinhalter, I guess I’m a member of the public,
 

but I’m also associated with the U.S. Department
 

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of Labor.
 

MS. MURRAY: Okay. 

DR. ZIEMER: Thank you. 

So at the moment those are the individuals
 

who are on the line. I was identifying the
 

documents that the Board needs to act on.
 

The first is a letter to Secretary Thompson
 

that deals with the Memorandum of Understanding
 

with DOE and with retention of records by DOE. 

That’s a one-page letter. The basic content of
 

this item was discussed at the meeting last week,
 

and it was a matter of wording the letter in an
 

appropriate fashion.
 

And then the second document consists of a
 

cover letter and two attachments. Again, the
 

cover letter to the Secretary indicating that the
 

Board is providing comments on 42 CFR Part 83,
 

and then the comments themselves are included in
 

two attachments: Attachment 1, which is called
 

General Comments; and Attachment 2, called
 

Specific Comments, which relate to specific
 

sections of the proposed rule making.
 

MS. MUNN: Paul, you’re almost being covered
 

up by the background noise again.
 

DR. ZIEMER: Okay. 

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MS. MUNN: I can hear you, but only barely.
 

DR. ZIEMER: Do we know – does everyone have
 

their cell phones on mute, or – that’s a little
 

better again, is it?
 

MS. MUNN: Yeah, much better.
 

DR. ZIEMER: That’s good.
 

MS. MUNN: And there is goes again.
 

DR. ZIEMER: Okay, well, we’ll do our best
 

here with the situation as it is.
 

Now what we’ll do is go through the documentS
 

one at a time. Before we vote on the specific
 

documents I will call for public comment on those
 

documents. 

The first (inaudible) deals with the single
 

letter relating to the Memorandum of
 

Understanding and the retention of records.
 

MS. MUNN: Background noise again.
 

DR. ZIEMER: Okay. Let me ask, I suppose for
 

the recorder, should I read the proposed letter? 

MS. MUNN: I think. 

DR. ZIEMER: I think so. Okay. 

MS. MUNN: Well, it seems to me we all have
 

it, the Board members all have it. Right?
 

DR. ZIEMER: We may need to read it for the
 

record.
 

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MS. MUNN: Okay. I have one question before
 

you do read it, Paul.
 

DR. ZIEMER: Yes?
 

MS. MUNN: Did we identify the appropriate
 

DOE number?
 

DR. ZIEMER: I have not gotten that 

information yet. Let me ask if – 

MR. ELLIOTT: This is Larry Elliott. I can 

respond to that. I have resurrected the memo 

from – the Department of Energy memo dated
 

October 28, 1991. It is (inaudible) Cori Homer,
 

and it will be attached to this letter and the
 

appropriate citations (inaudible). 

MS. MUNN: Oh, great. Okay. 

MR. ELLIOTT: So we can insert the citation
 

at the appropriate spot.
 

MS. MUNN: Yeah, that’s great. Thanks,
 

Larry. I’m sorry.
 

DR. ZIEMER: Okay. Let me proceed, then, and
 

read the letter. 

The date on the letter would be today’s date,
 

if it’s approved, which would be August 22nd ,
 

2002, addressed to The Honorable Tommy G.
 

Thompson, Secretary, Department of Health and
 

Human Services, Washington, D.C.
 

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Dear Secretary Thompson:
 

Since my last communication to you on
 

February 22, 2002, The Advisory Board on
 

Radiation and Worker Health has had three
 

additional meetings. The sessions were open to
 

the public in accordance with FACA requirements
 

and were attended by a variety of individuals
 

representing themselves or interest groups. 

Copies of the meeting agendas are attached for
 

your information.
 

During the Advisory Board meeting in
 

Cincinnati on August 14 and 15, two of the issues
 

under consideration relating to past records were
 

deemed to be of sufficient substance to require
 

your attention. The Board continues to be
 

seriously concerned about the critical need to
 

have complete personnel exposure records and
 

other related site records available in a timely
 

manner. The dose reconstruction process being
 

conducted by NIOSH, as required by law, cannot
 

function fairly and quickly in the absence of
 

those data. As the bulk of the required
 

information is accessible almost exclusively
 

through the Department of Energy, the Board
 

recommends that – now there are two bullets:
 

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Bullet one: A Memorandum of Understanding
 

between DHHS and DOE be pursued as expeditiously
 

as possible to assure NIOSH is provided timely
 

and appropriate DOE exposure records required by
 

Section 3623(e) of EEIOCPA. 

Bullet two: DOE be urgently requested to
 

reissue its directive on retention of personnel
 

records (the DOE Reference would be inserted
 

here) to each of their offices, contractors, and
 

former contractors to ensure that all necessary
 

data are appropriately retained and accessible. 

If there are questions, or if further
 

explanations of the Board's concerns are desired,
 

please advise accordingly.
 

Sincerely, Paul L. Ziemer, Ph.D., CHP, 

Chairman.
 

Now let me ask if any of the Board members
 

have comments, questions, or suggestions on this
 

letter. 

DR. DeHART: Paul, this Roy.
 

DR. ZIEMER: Right.
 

DR. DeHART: The second bullet, I would move
 

the word “urgently” to be inserted, and read DOE
 

be requested to urgently reissue.
 

DR. ZIEMER: Okay. It’s a matter of whether
 

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it’s the request is urgent or the reissue is
 

urgent. Maybe it’s the same. Let me get some
 

feedback here. We can do this by consent if
 

that’s agreeable. 

DR. DeHART: Yes.
 

DR. ZIEMER: What do others feel about that
 

word change, moving the word? 

It would be “be requested to urgently
 

reissue?”
 

DR. DeHART: DOE be requested to urgently
 

reissue.
 

MS. MUNN: I guess it’s not a big thing, but
 

my view was that we were urgently suggesting that
 

DOE do something urgently, that it get on the
 

ball to do it itself rather than to issue it as
 

an urgent directive, although both are
 

applicable.
 

DR. ZIEMER: As it stands now, (inaudible)
 

the urgency comes from NIOSH to get this request
 

out.
 

DR. DeHART: That’s my point. What we’re
 

wanting is that they urgently reissue directive. 

And I think it is a given that if we’re saying
 

urgently reissue we would also like to get the
 

memorandum out real quickly.
 

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UNIDENTIFIED: What we might want to do if –
 

DR. ANDERSON: (inaudible) say that HHS
 

should (inaudible) urgently, and (inaudible). 

We’re trying to cover two steps in this. The
 

first is the letter is to HHS. What we want HHS
 

to do is immediately contact DOE to reissue their
 

document. 

DR. ZIEMER: Right.
 

MR. ELLIOTT: This is Larry Elliott. 

(inaudible) remind you all that when you speak
 

you need to introduce yourself each time so the
 

recorder –
 

DR. ANDERSON: (inaudible) Henry Anderson.
 

MS. MUNN: This is Wanda. Can we take care
 

of the issue by using both words in two
 

respective places? Can we say DOE be urgently
 

requested to immediately reissue its directive?
 

UNIDENTIFIED: (inaudible)
 

DR. DeHART: That would be fine. 

DR. ZIEMER: Does that meet the – Roy, does 

that meet your – 

DR. DeHART: Yes. My point was that we’re 

trying to get DOE to respond quickly, and we’re
 

not really saying that. 

MS. MUNN: Right.
 

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DR. ZIEMER: Are there any objections to that
 

change that anyone has?
 

MS. MUNN: Oh, thank you whoever hung up.
 

DR. ZIEMER: It’s in the spirit of it. 

Unless I hear objections, I’m going to take it by
 

consent that that wording change would be
 

agreeable, so it would now read DOE be urgently
 

requested to immediately reissue its directive.
 

Is that okay? 

[No responses]
 

DR. ZIEMER: Other comments or suggestions? 

MR. GRIFFON: This is Mark Griffon. On the
 

first bullet, I was wondering if the Memorandum
 

of Understanding between DHHS and DOE be pursued,
 

or be completed as expeditiously as possible? I
 

think there’s already been a pursuit.
 

DR. ZIEMER: That’s quite true. It sounds
 

like the way it’s written now, it sounds like
 

this is something to get underway, where it is
 

already pretty far along.
 

MS. MUNN: Completed is probably stronger
 

language. 

MR. GRIFFON: I would recommend –
 

DR. ZIEMER: Everybody agreeable to
 

“completed?”
 

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UNIDENTIFIED: Yes.
 

UNIDENTIFIED: Yes.
 

DR. ZIEMER: Any objections? 

[No responses]
 

DR. ZIEMER: By consent, we’ll change that
 

“pursued” to “completed.” 

Thank you, Mark, for that suggestion. 

Others?
 

[No responses]
 

DR. ZIEMER: Okay, before we vote I want to
 

ask if any of the members of the public have
 

comments on this topic dealing with the DOE
 

records and the urgency of both obtaining them
 

and retaining them.
 

MS. GEST: I have a comment.
 

DR. ZIEMER: Thank you. Identify, and then –
 

MS. GEST: My name is Joy Gest from Hanford.
 

DR. ZIEMER: Thank you, Joy. Go ahead.
 

MS. GEST: I have received two letters from
 

NIOSH telling me that they have requested the
 

necessary radiation exposure records. I’ve
 

received two letters, so that leads me to believe
 

if I’ve received two letters asking for the same
 

information from DOE, DOE is the hangup. Is that
 

correct? 

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MR. ELLIOTT: This is Larry Elliott. 

MS. MUNN: Oh, it’s back, whatever that
 

background noise is. It’s returned with that
 

call.
 

UNIDENTIFIED: (inaudible)
 

MR. ELLIOTT: I’d answer your question,
 

though, in a general sense. The two letters may,
 

and I believe this is the case, represent our
 

initial request from DOE, and we – did the second
 

letter imply that we had received information, or
 

did it imply we had not received any to date?
 

MS. GEST: It sounded – I don’t have the
 

letters right in front of me, but it sounded to
 

me like you were requesting the same information
 

and that you had not received it yet.
 

MR. ELLIOTT: Okay. Well, the second letter
 

that goes back to DOE (inaudible) secondary level
 

information if the first submittal that they gave
 

us wasn’t as complete as we needed to do the dose
 

reconstruction, or it may be a reminder to DOE
 

that this particular request for a given claim
 

may have passed a given mark in time, such as a
 

120-day mark. So it’s just our attempt to keep
 

you apprized – you, the claimant – apprized of
 

our interaction with DOE in our pursuit of
 

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records for your claim. But I can’t speak
 

specifically with regard to your question. 

MS. GEST: It just seems to me like
 

(inaudible) process from the time I submitted my
 

claim, which I have done four different times,
 

that everyone involved in this (inaudible)
 

process is going extremely slow. It’s like the
 

right hand doesn’t know what the left hand is
 

doing.
 

DR. ZIEMER: Yes, and we appreciate that
 

problem. And part of the point of this – this is
 

Paul Ziemer – part of the point of this
 

memorandum is to help urge DOE to be timely in
 

those responses, and also concern that arose from
 

some comments from the members of the public that
 

records, as new contractors come into the
 

different facilities, that they may not be
 

cognizant of the need to preserve all of the old
 

records. 

We are trying to address those issues. And
 

whether it will address your specific one it’s
 

not clear, but at least we’re concerned about
 

both the retention and the timely availability of
 

records, and that’s the point of the letter. So
 

thank you for your comment.
 

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Are there any other general comments, or
 

comments from members of the public?
 

MS. COLLEY: I’d like to make one. And I
 

have just had to go to a pay phone, so it’s going
 

to be kind of noisy, and then I can get off here. 

This is Vina Colley from the Portsmouth Gaseous
 

Diffusion Plant.
 

DR. ZIEMER: Thank you. 

MS. COLLEY: And we’re really upset with the
 

process here of trying to get workers to sign
 

waivers to sign away their rights because they
 

don’t have a certain type of cancer. 

And we’re also upset because we’re not having
 

a meeting here at Piketon, or at least I haven’t
 

heard of one yet, and we ask that you do that.
 

And we also ask that you put all the sites as
 

special cohorts, because we all have been exposed
 

to many different types of chemicals. 

Particularly at the gaseous diffusion plants are
 

uranium hexaflouride, plus all the other
 

plutonium that we had that we weren’t supposed to
 

have. 

So they haven’t kept good records, so none of
 

us should have to prove anything. It’s time for
 

the Department of Energy to do the right thing.
 

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DR. ZIEMER: All right, thank you for that 

comment. 

Any others? 

MR. MILLER: Dr. Ziemer, this is Richard 

Miller. 

DR. ZIEMER: Yes, Richard. 

MR. MILLER: I just had a question. In the 

drafting of this letter, is this carbon copied to
 

the Secretary of Energy? Because it seems to me
 

as though you’re asking Secretary Thompson to
 

accomplish something which frankly is a bit
 

beyond his personal control, which is to have the
 

Energy Department reciprocate (inaudible) based
 

on his suasion. I realize you don’t have
 

jurisdiction pursuant to the Statute over at DOE,
 

but it seemed to me at least as a courtesy it
 

ought to be copied to the Secretary of Energy at
 

the same time.
 

MR. ELLIOTT: This is Larry Elliott, Richard,
 

and we will attend to those things within the
 

protocol that we have for corresponding between
 

departments. 

MR. MILLER: Oh, okay. Well, thank you,
 

Larry.
 

DR. ZIEMER: I don’t think it’s our
 

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prerogative to be – our job is to advise the
 

Secretary of Health and Human Services. And they
 

do have mechanisms for transmitting this
 

information, so I’m confident it will find the
 

proper target, as it were.
 

MR. MILLER: Now is this letter going to be
 

made publicly available on your web site as well?
 

DR. ZIEMER: Oh, yes. 

I’m correct on that, am I not? This would – 

MR. ELLIOTT: Yes, that --

DR. ZIEMER: This would be an official
 

recommendation of the Board. 

MR. ELLIOTT: It will be a matter of part of
 

the docket for the proposed rule. So that is
 

accessible, all those comments are accessible on
 

the web site.
 

DR. ZIEMER: Actually, this letter is
 

separate from the rule making. 

UNIDENTIFIED: True, that’s true.
 

DR. ZIEMER: But it still would be available
 

on the web site, certainly, as all the other
 

recommendations are.
 

UNIDENTIFIED: Dr. Ziemer, one last point,
 

and that is – it’s sort of off the point of this
 

letter, but only slightly – and that was your
 

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committee has received public comment with
 

respect to concern that NIOSH lacks adequate
 

staffing to do all of the enormous tasks that you
 

have ahead of us. 

Is there going to be some way to address
 

communication with the Secretary of Health and
 

Human Services on that, or – I’m not suggesting
 

it be part of this letter, but I don’t know if
 

that could be added to the agenda for today. But
 

I know that the Senate had weighed in recently
 

with some language in a Senate appropriations
 

bill for Labor/HHS encouraging the Secretary’s
 

office to give NIOSH some staff to actually do
 

the task ahead. And if there’s a way to respond 

I’d – 

DR. ZIEMER: Well, you may recall that we had 

a discussion on that issue at our meeting a week
 

ago, and also we have it on the agenda for next
 

time in terms of evaluating where things are when
 

the new contractor gets the dose reconstruction
 

contractors in place. 

So it’s an ongoing issue that we have before
 

us, but certainly is not an agenda item for the
 

meeting today. But your comment will be in the
 

record, of course. 

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MS. GEST: I would like to make a comment
 

also, since he brought this up.
 

DR. ZIEMER: Please identify yourself for the
 

record.
 

MS. GEST: Mrs. Joy Gest.
 

DR. ZIEMER: Joy.
 

MS. GEST: I understand that at the present
 

time NIOSH only has three people who are looking
 

at the claims for dose reconstruction. 

(Inaudible) correct statement? And there have
 

only – at the present moment have only processed
 

five to seven claims out of what, approximately?
 

MR. ELLIOTT: This is Larry Elliott. There
 

are more than three actually working on dose
 

reconstruction efforts here at NIOSH.
 

MS. GEST: Okay, give me an approximate. 

MR. ELLIOTT: Well, I would say that every
 

one of my staff is working on these claims as
 

they come through. 

MS. GEST: And how many people are we talking
 

about?
 

MR. ELLIOTT: So I would answer your question
 

this way, that we all must recognize and
 

understand that a compensation program that’s
 

being implemented is difficult in and of itself,
 

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and it’s a legal process which requires us to be
 

very careful and deliberative in the process. 

And if we compare that process to other
 

compensation program processes, (inaudible) see
 

that in other processes, other compensation
 

programs, it takes approximately a year for a
 

claim to move through the system. 

Now as soon as the contract is awarded that
 

NIOSH has pending for dose reconstruction
 

support, I fully expect to see a larger number of
 

claims being processed.
 

MS. GEST: Okay. I still didn’t get an
 

answer to the question of how many claims have
 

been processed, or are in the process at the
 

moment.
 

MR. ELLIOTT: Well, if you go on our web site
 

you’ll see that we have a little over 6,700
 

claims in our hands right now. We have finalized
 

and sent over to the Department of Labor for
 

recommended decision or a final decision, I
 

believe we’re up to seven now of those claims. 

And we are just about ready to send some more
 

over this week. There are a variety of steps in
 

the process, and at each given step there’s a
 

different number of claims.
 

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MS. GEST: Well, I guess –
 

DR. ZIEMER: But also, you have a contractor
 

shortly coming aboard. And once the contract is
 

approved, that will greatly expedite the handling
 

of these. Is that correct? 

MR. ELLIOTT: Yes, that is correct.
 

MS. GEST: Okay, what are we talking about, a
 

greatly (inaudible)? It seems to me like this
 

process – I guess one of my main comments would
 

be is it looks to me like we’re not setting a
 

high enough priority for the people who put in
 

claims. Other things are getting in the way –
 

September 11th and the war effort, whatever. We
 

don’t have enough clout, those of us who put in
 

claims, and we keep writing to people (inaudible)
 

seems to me like anybody with (inaudible) –
 

MS. NEWSOM: Excuse me, I can’t hear 

anything. 

DR. ZIEMER: Sounds like it’s breaking up 

here. 

UNIDENTIFIED: I’m going to have to ask that
 

whoever’s contributing to the background noise is
 

going to have to hang up and find another phone.
 

Thank you. 

DR. ZIEMER: That’s better again.
 

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In any event, the NIOSH group is certainly
 

moving forward on getting the contractor aboard. 

There will be a goodly number of individuals
 

working strictly on this process of dose
 

reconstruction and processing of claims. So it’s
 

not – the NIOSH staff is just getting the process
 

underway, but they will have –
 

MR. ELLIOTT: Let me ask a question
 

(inaudible) Ms. Gest – this is Larry Elliott
 

again. Once we have the contractor aboard, the
 

contractor is supposed to be staffed and equipped
 

to handle 8,000 claims per year as a minimum.
 

MS. GEST: Okay. And we’re talking about
 

whoever this contractor is who has expertise in
 

looking at these records?
 

MR. ELLIOTT: Yes. Ma’am, we’re not – if
 

you’d like to make a comment for the record
 

today, that’s what we would ask you to do. We
 

don’t have time to debate and question and
 

answer. So (inaudible) comment for the record,
 

please do so. But I’d ask you to make your
 

comment, and then we need to move along.
 

MS. GEST: Okay. 

DR. ZIEMER: Any further comments?
 

[No responses]
 

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DR. ZIEMER: Okay. Board members, are you
 

ready to act on this document? Is there anyone
 

not ready to vote?
 

[No responses]
 

DR. ZIEMER: What we have before us now would
 

be approval of the letter relating to the
 

Memorandum of Understanding and the retention of
 

personnel records. Are you ready to vote?
 

[No responses]
 

DR. ZIEMER: I hear silence. Does that mean
 

you’re ready to vote? 

All who favor the document with those two
 

minor changes in wording that we agreed to,
 

please say aye. 

UNIDENTIFIED: Dr. Ziemer, I think you’ll
 

have to have a roll call.
 

DR. ZIEMER: Yes, we’ll do a roll call. Can
 

the –
 

MR. ELLIOTT: Cori could do that.
 

DR. ZIEMER: Cori, can you do the roll call?
 

MS. HOMER: Yes. As soon as I can find my
 

roster, now that it’s buried. Okay. 

DR. ZIEMER: If you favor this document say
 

aye; if you oppose say no.
 

MS. HOMER: Dr. Ziemer?
 

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DR. ZIEMER: Yes.
 

MS. HOMER: Dr. Anderson?
 

DR. ANDERSON: Yes.
 

MS. HOMER: Dr. Andrade?
 

DR. ANDRADE: Yes.
 

MS. HOMER: Dr. DeHart?
 

DR. DeHART: Yes.
 

MS. HOMER: Mr. Espinosa?
 

MR. ESPINOSA: Yes.
 

MS. HOMER: Ms. Gadola?
 

[No responses]
 

MS. HOMER: Ms. Gadola?
 

MS. GADOLA: Yes.
 

MS. HOMER: Mr. Griffon?
 

MR. GRIFFON: Yes.
 

MS. HOMER: Dr. Melius?
 

DR. MELIUS: Yes.
 

MS. HOMER: Munn?
 

MS. MUNN: Yes.
 

MS. HOMER: Mr. Presley?
 

MR. PRESLEY: Yes.
 

MS. HOMER: Okay. It’s unanimous.
 

DR. ZIEMER: Thank you. The motion carries,
 

and that will go with our recommendation to
 

Secretary Thompson.
 

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Now the next document and attachment consists
 

of a cover letter to Secretary Thompson. Let me
 

read the letter. And the letter itself, although
 

we can reword it if necessary, does not contain
 

any recommendations. It is simply a cover
 

letter, but I will read it for the record:
 

August 20, 2002, The Honorable Tommy G.
 

Thompson, Secretary, Department of Health and
 

Human Services, Washington, D.C.
 

Dear Secretary Thompson:
 

During meetings held May 2nd and 3rd, 2002,
 

July 1st and 2nd, 2002, and August 14 and 15, 2002,
 

The Advisory Board on Radiation and Worker Health
 

examined the provisions of the Department of
 

Health and Human Services proposed rule 42 CFR
 

Part 83 entitled Procedures for Designating
 

Classes of Employees as Members of the Special
 

Cohort Under the Energy Employees Occupational
 

Illness Compensation Program Act of 2000.
 

At the Board sessions, formal presentations
 

were provided by NIOSH staff members concerning
 

the Special Exposure Cohort issues. In addition,
 

presentations were made by outside experts,
 

including individuals from the Department of
 

Veterans Affairs. Members of the public also
 

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provided valuable input on this matter.
 

Under the provisions of the President's
 

Executive Order of December 7th, 2000, the
 

Advisory Board has very specific responsibilities
 

on advising the Secretary of Health and Human
 

Services. In accordance with those
 

responsibilities, I am pleased to provide the
 

Advisory Board's comments and recommendations
 

concerning the proposed procedures set forth in
 

42 CFR Part 83. These comments and
 

recommendations are summarized in Attachments 1
 

and 2. Attachment 1 provides general comments on
 

certain aspects of the proposed rule. Attachment
 

2 provides more specific comments on particular
 

sections of the proposed rule.
 

Please let me know if additional information
 

or clarification is needed. 

Sincerely, Paul Ziemer, et cetera. 

Now let me ask, although this has no
 

recommendations, you may wish to help me improve
 

wording on this. 

MR. ELLIOTT: Dr. Ziemer, this is Larry
 

Elliott. I would suggest to you all that in the
 

first sentence, during meetings held May 2nd and
 

3rd, and tying that with examining the provisions
 

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of 42 CFR 83, I don’t believe that actually
 

happened in that May meeting. Our Notice of
 

Proposed Rule Making were not presented to you at
 

that time. They were not ready.
 

DR. ZIEMER: That’s right.
 

MR. ELLIOTT: (inaudible) did, however, I
 

believe the transcript will show, have some
 

discussions. You certainly asked us questions
 

about the status of this, of the guidelines or
 

rule at that time, but I don’t believe you
 

examined the provisions.
 

DR. ZIEMER: On May 2nd and 3rd, because that
 

draft was not out yet. That’s quite correct.
 

MR. ELLIOTT: So you can work with the
 

language a little bit, but just to – apart from
 

that. 

DR. ZIEMER: It’s not necessary that we have
 

the May 2nd and 3rd in there, probably. I mean,
 

it’s –
 

MS. MUNN: This is Wanda. We could say
 

examine issues relevant to the Department of
 

Health and Human Services proposed rule, rather
 

than provisions of.
 

UNIDENTIFIED: And leave May 2nd and 3rd in.
 

MS. MUNN: Yeah, if you were going to leave
 

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May 2nd and 3rd in –
 

DR. ZIEMER: Examine issues relevant to?
 

MS. MUNN: Um-hum (affirmative). 

DR. ZIEMER: Which doesn’t mean that we
 

necessarily examined that document on that day.
 

MS. MUNN: That’s correct. 

DR. ZIEMER: That certainly will make it more
 

correct. Anyone object to that or have a better
 

solution?
 

[No responses]
 

DR. ZIEMER: So examined issues relevant to
 

the provisions?
 

MS. MUNN: Um-hum (affirmative). 

DR. ZIEMER: Okay. Everybody okay on that? 

MR. PRESLEY: Bob Presley. Sounds good to
 

me.
 

DR. ZIEMER: Okay. And then – well, let me
 

ask for any other comments or suggestions on the
 

letter itself.
 

DR. ANDERSON: Paul, this is Henry Anderson.
 

DR. ZIEMER: Yes, Henry?
 

DR. ANDERSON: I’m going to have to step out
 

here, and I just want to say that I’m supportive
 

of the letter and would vote for it, as well as
 

the two attachments. If there’s some minor
 

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wordsmithing that’s fine with me. But I just
 

want you to record my vote in favor of these two. 

I’ll get back on the line, but they’re waving
 

frantically at me here.
 

DR. ZIEMER: Oh, okay. Thank you. 

DR. ANDERSON: Okay. 

DR. ZIEMER: Thank you. 

DR. ANDERSON: Sure thing.
 

DR. ZIEMER: Henry?
 

DR. ANDERSON: Yeah?
 

DR. ZIEMER: If you’re able to, come back on.
 

DR. ANDERSON: Oh, I will. 

DR. ZIEMER: I have a couple of items that I
 

want to raise on some items here.
 

DR. ANDERSON: Okay. 

DR. ZIEMER: Okay. 

DR. ANDERSON: Thank you. 

DR. ZIEMER: Thank you. 

Okay, we don’t need to vote on the letter at
 

the moment. We’re just getting wording on that. 

What we need to vote on are the attachments. 

Let’s go to Attachment 1, unless someone had
 

any other comments on the letter? 

[No responses]
 

DR. ZIEMER: Okay. Attachment one. Let’s go
 

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41 

through this section by section, if that’s
 

agreeable. 

First section, on non-SEC listed – oh, what
 

I’ll do now, let me read each section for the
 

recorder here. On Attachment 1, the first
 

section is called Non-SEC Listed Cancers. The
 

comment is this: 

The Board noted that there were a number of
 

unresolved issues concerning how to handle
 

claimants who were part of an SEC class who
 

developed a non-SEC listed cancer. The Board
 

recommends that NIOSH carefully review the
 

proposed regulations to ensure that they do not
 

preclude appropriate handling of these cases. 

The Board also recommends that NIOSH develop
 

appropriate procedures to address situations
 

where part but not all of a claimant’s dose
 

history is included in an SEC class. 

Now that’s the paragraph. Let me ask if
 

anyone has any comments, corrections, suggested
 

changes? 

DR. DeHART: This is Roy with just a word
 

change. It’s on the third line. It’s the word
 

“they” could be interpreted to refer back to
 

NIOSH rather than to the regulation. I would
 

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suggest then that it read proposed regulation to
 

ensure that these do not preclude.
 

DR. ZIEMER: Okay, these.
 

DR. DeHART: Yes.
 

UNIDENTIFIED: (inaudible)
 

DR. ZIEMER: (inaudible) because it’s plural
 

that it’s regulations?
 

DR. DeHART: Yes.
 

DR. ZIEMER: Anybody object to that? 

[No responses]
 

DR. ZIEMER: It’s a clarity issue. Thank
 

you. 

Any others?
 

[No responses]
 

DR. ZIEMER: Okay. Let’s – well, let me ask
 

the group now, do you want to get all comments
 

and then vote on the document as a whole, or does
 

anyone wish to separate the document into
 

sections?
 

MS. MUNN: Let’s get the whole thing
 

(inaudible), unless we get a particularly thorny
 

issue.
 

DR. ZIEMER: Okay. Well, I’m going to raise
 

an issue here in a moment. In fact, I’ll raise
 

it under the health endangerment. 

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Let me read the document first. The second
 

section, Health Endangerment:
 

Some of the Board members felt that the
 

proposed rule for determining whether a potential
 

SEC class meets the criteria of “health
 

endangerment" was not adequate. In particular,
 

the proposed method for estimating whether the
 

cohort met the criteria for "health endangerment"
 

was not adequately justified and could lead to
 

arbitrary and unfair decisions. These members
 

recommended that NIOSH consider criteria similar
 

to those used for the current SEC classes based
 

on duration of work in a facility in a situation
 

where the monitoring of radiation exposures was
 

required or should been required (after first
 

determining that the information was not adequate
 

for individual dose reconstruction).
 

Okay, that is the document or this statement
 

as it stands. 

Now one of the issues, and we brought it up
 

at the meeting, was that this may not represent a
 

consensus of the Board, this particular
 

statement. It may represent the views of some of
 

the Board. In fact, it appeared to be split at
 

the meeting. 

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The question really arises – and now in my
 

mind, as I look at this further as to whether or
 

not the Advisory Board should be putting forth to
 

the Secretary something that is not necessarily a
 

consensus view – this may or may not be a
 

consensus view. At the meeting I was suggesting
 

that we at least have it in the document to look
 

at for today to see whether or not there was
 

consensus on this item of health endangerment. 

If there is not, then I am questioning whether it
 

should even be in the document since it would
 

then not be a consensus view.
 

DR. ANDRADE: Paul? 

DR. ZIEMER: So let’s have some discussion on 

that issue. 

DR. ANDRADE: Paul? 

DR. ZIEMER: Yes. 

DR. ZIEMER: Tony Andrade. 

DR. ZIEMER: Tony. 

DR. ANDRADE: I feel that the statement needs 

to have a little bit more clarification for it to
 

be palatable, at least to me. Just working in a
 

facility for a period of time, like 250 days,
 

without adequate monitoring in and of itself does
 

not mean anything to anybody. That is completely
 

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arbitrary. 

There has to be another indicator. There has
 

to be an “and” statement in there. For example,
 

working at a facility in a situation where the
 

monitoring of radiation exposures was required,
 

and there was evidence of either external or
 

internal – potential for external or internal
 

dose. Without that, then we’re getting back to
 

this arbitrariness that Congress dealt us in
 

establishing the first cohort to begin with. 

DR. ZIEMER: Okay. Other comments?
 

DR. DeHART: This is Roy. In reviewing this,
 

I had simply lined through everything following
 

“these members recommend that.” I have no
 

objection at all to the Board bringing up that
 

there is confusion and problems, perhaps, with
 

health endangerment as a definition. But I would
 

not approve recommending NIOSH be instructed as
 

to what to consider. 

DR. ZIEMER: Okay. So your recommendation is 

to – 

DR. DeHART: My recommendation – 

DR. ZIEMER: Statement but no recommendation? 

DR. DeHART: That’s correct. We would stop 

at “these members recommend that NIOSH consider.” 

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DR. ZIEMER: Okay. Let me ask for other
 

comments now. Right now we’re just listening. 

We can ask for specific motions to amend here in
 

a moment.
 

MS. MUNN: This is Wanda. 

I wish I had thought of that, Roy. I agree. 

I can see – I think it’s appropriate for us
 

to mention that there is concern on the Board
 

with respect to what health endangerment
 

essentially means, but I am likewise hesitant to
 

make this statement that’s made in the last
 

sentence. The first two sentences, I think, are
 

approveable. 

DR. ZIEMER: Okay, other comments?
 

DR. ANDRADE: This is Tony Andrade again. I
 

could support that. I think if we leave the
 

sentence as recommend that NIOSH consider
 

suitable criteria or something to that effect, or
 

consider this issue, period, which leaves it a
 

little open-ended and gives us some time to work
 

with it, then I would certainly support Dr.
 

Anderson’s comment.
 

MR. PRESLEY: This is Bob Presley. I agree. 

DR. ZIEMER: Let me ask the question of those
 

who have commented so far, what you would have
 

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left is a statement that some Board members felt
 

something or other. 

But what I’m asking now is that would, as it
 

is written here, it would appear to go to the
 

Secretary as a sort of minority report thing,
 

which is not what we’re asked to do. The
 

Secretary wants to know what the Board by
 

consensus agrees to. It’s one thing to say that
 

we agree that some of our members have this
 

concern, but if not a majority has this concern
 

then I ask the question, do we send it on to the
 

Secretary? 

If those who just spoke feel that you could
 

agree to this concern if it were written in the
 

abbreviated way – that is, that it was a Board
 

consensus that there is a concern about the
 

criteria without spelling out how it goes – then
 

it becomes a consensus. Do you see what I’m
 

saying?
 

MS. MUNN: Yes. 

This is Wanda. I have an additional
 

suggestion. Could the third sentence then read,
 

these members recommend that NIOSH consider this
 

issue be more extensively defined?
 

DR. MELIUS: This is Jim Melius. I need to
 

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48 

clarify things procedurally. I don’t see where
 

there’s any requirement that the Board put forth
 

a consensus recommendation. We’ve attempted to
 

do that, but it’s not something that’s required
 

of us. And I think procedurally, my
 

understanding from the last meeting that we were
 

putting forth in this particular paragraph, and I
 

think in one other place, some criteria that
 

there are some recommendations that we recognize
 

were not unanimously agreed to by – were not
 

being unanimously agreed to by the Board. 

If that’s the case, then I have some question
 

– you know, I guess we can go two ways. One is
 

we can try to make them, reword them to make them
 

a consensus, or we can leave them as they are. 

And I guess I would object to people trying to
 

reword what some members of the Board feel should
 

be recommended when they didn’t agree with the
 

point to begin with. 

DR. ZIEMER: That was sort of what I was
 

saying, Jim, that if people are trying to reword
 

others’ views, that’s one thing. If we’re
 

rewording so that it becomes a consensus view,
 

that’s a different issue.
 

Personally, I’m comfortable with simply
 

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enumerating all views on everything. I think
 

advisory boards in general are called on to
 

provide the consensus view. 

Now in saying that, let me tell you that I
 

have no personal qualms with other views going
 

forward. I’m not sure that the system is
 

comfortable with that. By the system, I’m
 

talking about advisory boards in general, which –
 

and even NIOSH in how it operates. So –
 

MR. ELLIOTT: Dr. Ziemer?
 

DR. ZIEMER: Yeah?
 

MR. ELLIOTT: This is Larry Elliott, if I
 

might speak. Certainly, I think you’re both
 

right. 

Under FACA, which this advisory body has to
 

operate, the intention is to provide consensusbased advice. And the Department and the
 

Secretary, I think, feel that if there are
 

individuals who have another opinion or another
 

perspective, they certainly have been afforded
 

the opportunity to provide that as an individual. 

And as an individual that’s going to carry in, I
 

think, their mind more weight than – as equal
 

weight to consensus advice coming from an
 

advisory body than if the report from the
 

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advisory body says some members, a few members,
 

or a member. And I’d just offer that for
 

everyone’s understanding of how the Department
 

views this. 

MS. HOMER: This is Cori. While I’m sitting
 

here, I pulled up the Operational Guidelines that
 

was discussed and agreed upon at the very first
 

meeting. And the paragraph two reads that the
 

Board shall issue formal recommendations on
 

specific matters to HHS/NIOSH only after a
 

majority opinion has been reached through voting
 

by eligible members.
 

I’m not sure if that clarifies things for
 

you, but –
 

DR. ZIEMER: Well, one of the things that we
 

had sort of entertained was a majority could
 

agree to allow a minority view to be included. 

Do you understand what I’m saying? 

In other words, we could, I think, under that
 

plan vote to allow the view to go forward. 

Everyone, we could by vote say this is the
 

paragraph we want to go forward, so even though
 

the content would not have represented a
 

consensus. Or maybe it will. I think it was a
 

very close vote last time, as I recall.
 

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In any event, I must say that my preference
 

would be to have things go forward not just
 

pointing out minority views, but things that
 

everybody said yes, we all – we, consensus-wise,
 

maybe not all – but we agree that this is an
 

issue. And if the definition of health
 

endangerment itself, if the definition, if that’s
 

a concern to most, that can be a majority thing.
 

The solution of it may be different in
 

people’s minds. In one case it may be in terms
 

of a required time of work at a site or whatever. 

DR. DeHART: Paul, this is Roy. I would
 

recommend – I don’t know if we’re ready to vote
 

on anything or not, but anyway –
 

DR. ZIEMER: Well, that’s why I originally
 

said we need to take this by sections, because
 

this may be an example of such.
 

DR. DeHART: I’m quite willing to agree,
 

because of our discussions and the difference of
 

opinions that were there that health endangerment
 

as a term needs to be better defined, and I would
 

be quite willing to see that as a Board position. 

But I would take exception with trying to define
 

it.
 

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MR. TABOR: I don’t see how you gain anything
 

by that. 

DR. ZIEMER: I’m sorry?
 

MR. TABOR: This is Bob Tabor here. You
 

people were in a discussion there. I don’t think
 

you’re ready for any comments.
 

DR. ZIEMER: Right now limiting this to Board
 

discussion. Thank you, Bob.
 

MR. TABOR: Fine.
 

DR. ZIEMER: Other –
 

MS. MUNN: This is Wanda again. As you know
 

from our discussion in the Board itself, I felt
 

that the definition that was given was reasonable
 

enough. 

For that reason, I hesitate to begin to make
 

those definitions ourselves as a Board. And I
 

guess I would prefer to go back to Roy’s initial
 

suggestion, that the comments after the first two
 

sentences be deleted. As our current discussion
 

has pointed out, if those members who feel
 

otherwise feel strongly enough about it we or
 

they are certainly free to make individual
 

comments to the Secretary. 

DR. ZIEMER: Do I understand your comment,
 

Wanda, to mean that you do not object to having a
 

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53 

statement that says some Board members who are
 

concerned about adequacy, whatever the statement
 

is here at the beginning –
 

MS. MUNN: Yes.
 

DR. ZIEMER: Deleting the rest, as Roy has
 

suggested? 

MS. MUNN: Yes. I can see no problem with
 

the first two sentences that shows that there was
 

a difference of opinion on the Board, but I think
 

we can spend a lot of time not necessarily
 

productively trying to meld the differences that
 

exist.
 

DR. ZIEMER: Any other comments?
 

MR. GRIFFON: Yeah, this is Mark Griffon. I
 

mean, it does go back to that question of can we
 

reach consensus on this, or are we going to allow
 

this minority position to stay of some Board
 

members? I think if I’m interpreting what Roy
 

just said correctly, he could vote for something
 

that’s slightly edited where we don’t make a
 

recommendation, but we as an entire Board –
 

DR. ZIEMER: Have raised the issue.
 

MR. GRIFFON: We as an entire Board feel that
 

there is a problem with this definition, and we
 

think that NIOSH needs to further consider other
 

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54 

suitable criteria, period, and we don’t lay out
 

that specific recommendation that’s more to the
 

other SEC stuff. I guess I see that as sort of a
 

middle ground, a consensus. 

DR. ZIEMER: Is that what you were 

suggesting, Roy? 

DR. DeHART: Yes, it is. 

MR. GRIFFON: But that’s different than – 

DR. ZIEMER: And that’s different than the 

feeling that it’s – 

MR. GRIFFON: And I guess my feeling is that
 

if we’re going to leave it as some Board members,
 

then as Jim Melius stated earlier, some Board
 

members – and I think we were actually challenged
 

for, well, what are the other criteria during the
 

meeting, and we laid out one option.
 

DR. ZIEMER: But not necessarily all.
 

MR. GRIFFON: And I think that some Board
 

members felt that that option was a suitable
 

criteria. So if we’re going to edit out the
 

option or the recommendation, then maybe we – I
 

might be agreeable to that, if we’re building a
 

consensus opinion for the entire Board, to state
 

that there’s a problem with this definition of
 

health endangerment. 

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DR. ZIEMER: Let’s try the following. 

Roy, if you’re willing to make a motion, I
 

think your motion would have been the Board
 

members – and maybe instead of “felt” we use the
 

word “suggest” – the Board members suggest that
 

the proposed rule determining whether potential
 

SEC class meets health endangerment was not
 

adequate, and in particular – in other words, the
 

next – the sentences as given, and then ending
 

after “unfair decisions.” Is that what you are
 

wanting to move? 

DR. DeHART: Yes, I would. That the Board – 

DR. ZIEMER: The Board, not some of the 

Board? 

DR. DeHART: Yeah, that the Board felt. Not 

members, but that the Board felt that –
 

DR. ZIEMER: Or can I suggest the word
 

“suggest?” 

DR. DeHART: Yes.
 

DR. ZIEMER: Board members suggest that? 

DR. DeHART: That’s fine.
 

MR. GRIFFON: And Roy, not to put words in
 

your mouth, but would you add one additional line
 

from the next section saying that the Board
 

recommends that NIOSH consider other suitable
 

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56 

criteria, period, or something to that effect? 

DR. DeHART: I think that’s a given, but I’ll 

accept that. 

DR. ZIEMER: Okay, is that a motion, Roy? 

DR. DeHART: I’ll make it a motion. 

DR. ZIEMER: Is there a second? 

MR. PRESLEY: Bob Presley, I have second. 

DR. ZIEMER: Okay, we have a second. Now 

let’s have discussion on this, then. And that
 

motion would delete the sentence starting with
 

“these members” through the end of the paragraph,
 

is that correct? 

DR. DeHART: It would. 

DR. ZIEMER: Okay, is there discussion? 

MS. MUNN: This is Wanda. That’s getting
 

convoluted in my simple mind. If I understood
 

the suggestion correctly, we’re working toward a
 

consensus statement here.
 

DR. ZIEMER: Right.
 

MS. MUNN: Therefore, removing the statement
 

that some of the Board felt this way, and
 

therefore inferring that what we’re going to say
 

is the consensus of the entire Board?
 

DR. ZIEMER: That’s correct, or the consensus
 

as defined by our voting procedure. 

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Cori, what did we say it required for
 

consensus? 

MS. HOMER: (inaudible) moment I’ll
 

(inaudible) that back up.
 

DR. ZIEMER: On our working rules as far as
 

the percent of those voting.
 

MS. HOMER: I’m not sure we defined a quorum,
 

did we?
 

MR. GRIFFON: Is there some background
 

conversations? I’m sorry, I’m having a hard 

time. 

MS. MUNN: Again, may I be really ugly and 

suggest that whoever is carrying on another
 

conversation just go offline.
 

MS. HOMER: Well, it does define eligible
 

members, which is not an issue. I’m looking to
 

see – I’m believing a quorum is one more than one
 

half – 

DR. ZIEMER: Yes.
 

MS. HOMER: – Is how we defined it, but I
 

can’t find it specifically without –
 

DR. ZIEMER: No, definition of consensus, not
 

of quorum.
 

UNIDENTIFIED: Majority. I believe you
 

established that it was a majority –
 

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DR. ZIEMER: Majority of –
 

MR. GRIFFON: Simple majority, yeah.
 

MS. HOMER: Yeah, only after a majority
 

opinion has been reached through voting by
 

eligible members.
 

DR. ZIEMER: Okay. 

MR. PRESLEY: This is Bob Presley. That’s
 

what I remember. 

DR. ZIEMER: The motion, then, is as follows: 

That we would have a statement that says the
 

Board members suggest that the proposed rule for
 

determining whether a potential SEC class meets
 

the criteria of health endangerment was not
 

adequate. In particular, the proposed method for
 

estimating whether the cohort met the criteria
 

for health endangerment was not adequately
 

justified and could lead to arbitrary and unfair
 

decisions. The Board – and you had another
 

sentence, Roy, or somebody did, or maybe it was
 

Mark.
 

DR. DeHART: Mark came in with it.
 

MR. GRIFFON: I was just adding on the Board
 

recommends that NIOSH consider other suitable
 

criteria, period, which would drop off the
 

specific –
 

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59 

DR. ZIEMER: And I think that was part of
 

your motion, Roy, is that correct? 

DR. DeHART: Yes, that would be fine.
 

DR. ZIEMER: The Board recommends that NIOSH
 

consider other suitable – what?
 

MR. GRIFFON: Criteria, period. Yes.
 

MS. MUNN: Could you use “additional” rather
 

than “other suitable,” because you’re inferring
 

that the current criterion doesn’t mean anything. 

And I guess I object to that assertion.
 

DR. ZIEMER: Additional – other or
 

additional? 

MS. MUNN: Additional criteria, because – 

MR. GRIFFON: Well, additional is different.
 

MS. MUNN: – if you use “other,” then the
 

inference is throw out the current criteria and
 

choose something else.
 

MR. GRIFFON: It says consider other – yeah,
 

suitable. But it doesn’t necessarily mean that
 

they have to (inaudible). 

UNIDENTIFIED: But I think --

MR. GRIFFON: Additional is different, you
 

know. 

DR. ZIEMER: It doesn’t mean that they can’t
 

retain the ones, right?
 

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60 

DR. DeHART: That’s correct. 

DR. ZIEMER: Okay. So as you’re suggesting
 

it would read consider other suitable criteria.
 

Any other comments on the motion?
 

[No responses]
 

DR. ZIEMER: I don’t hear any. We’re vote,
 

then. If the motion passes, this now would
 

become the item on health endangerment. Okay,
 

we’ll –
 

UNIDENTIFIED: Cori call the roll?
 

DR. ZIEMER: Call the roll.
 

MS. HOMER: I’ll do so.
 

Okay, Dr. Ziemer?
 

DR. ZIEMER: Yes.
 

MS. HOMER: Dr. Anderson?
 

DR. ZIEMER: He’s gone.
 

MS. HOMER: That’s correct. 

Dr. Andrade?
 

DR. ANDRADE: Yes.
 

MS. HOMER: Dr. DeHart?
 

DR. DeHART: Yes.
 

MS. HOMER: Mr. Espinosa?
 

MR. ESPINOSA: Yes.
 

MS. HOMER: Ms. Gadola?
 

MS. GADOLA: Yes.
 

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61 

MS. HOMER: Mr. Griffon?
 

MR. GRIFFON: Yes.
 

MS. HOMER: Dr. Melius?
 

DR. MELIUS: Yes.
 

MS. HOMER: Ms. Munn?
 

MS. MUNN: No.
 

MS. HOMER: Mr. Presley?
 

MR. PRESLEY: Yes.
 

MS. HOMER: And Dr. Roessler is not on the
 

call.
 

DR. ZIEMER: So what is the total vote? How
 

many yeas?
 

UNIDENTIFIED: Eight yeas, one no.
 

DR. ZIEMER: Eight and one.
 

MS. HOMER: Um-hum (affirmative).
 

DR. ZIEMER: No abstentions.
 

MS. HOMER: And one unavailable.
 

DR. ZIEMER: Yeah. But it’s only those
 

present and voting.
 

MS. HOMER: Um-hum (affirmative). 

MR. ELLIOTT: Cori – Larry – I would suggest
 

that on the next set of votes you ask Dr. Ziemer
 

for his vote last.
 

MS. HOMER: All right. 

DR. ZIEMER: Okay, then we have completed
 

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62 

that one. 

Let’s go on to Dose Reconstruction
 

Guidelines. Let me read the draft
 

recommendation: 

The Board recommends that NIOSH clarify the
 

criteria for determining that it was not possible
 

to complete an individual dose reconstruction
 

with sufficient accuracy. These criteria should
 

be more completely outlined in the preamble to
 

the final rule in order to assist potential SEC
 

class applicants to understand the criteria that
 

will be used for evaluating an applicant for SEC
 

class designation. The Board also recommends
 

that NIOSH develop operational guidelines
 

outlining the criteria for determining that the
 

available data are not adequate for conducting
 

individual dose reconstruction. These guidelines
 

should be reviewed by the Board. The Board
 

believes that these guidelines are necessary for
 

ensuring consistency and fairness in these
 

important determinations.
 

Okay, comments?
 

MS. MUNN: This is Wanda. I have no problem
 

at all with the content or context. 

In re-reading this this morning, I had a
 

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slight editorial comment, but I don’t know
 

whether it improves it or not, now that I look at
 

it.
 

In the second sentence, which is rather
 

lengthy and gets a bit sticky toward the end of
 

the sentence, at least trying to read it simply
 

(inaudible), I considered whether in the third
 

line of that sentence toward the end there,
 

evaluating – the criteria will be used for
 

evaluating an applicant for inclusion in any SEC
 

designation. 

Is that any clearer, or does it just add more
 

words?
 

DR. ZIEMER: For inclusion?
 

MS. MUNN: Um-hum (affirmative), in any SEC
 

designation. The duplication of the word “class”
 

there stopped me a couple of times.
 

DR. ZIEMER: I agree that that certainly
 

reads better. 

Anyone object to that, evaluating an
 

applicant for inclusion in any, was it?
 

MS. MUNN: Yes, in any SEC designation. 

DR. ZIEMER: Anyone object to that? It
 

doesn’t change the meaning –
 

MS. MUNN: No.
 

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64 

DR. ZIEMER: – But maybe reads better.
 

[No responses]
 

DR. ZIEMER: Okay, let’s agree to do that. 

Thank you, Wanda.
 

Other comments or suggestions? 

DR. DeHART: This is Roy. I have a
 

substantive change. We spent some time talking
 

about time limits, and I realize that guidelines
 

could include time and perhaps should. I would
 

like to make sure that it does by including it. 

So I would add to the, I guess, third
 

sentence down, the Board also recommends that
 

NIOSH develop operational guidelines outlining
 

the criteria to include time limits for
 

determining that the available data, et cetera. 

DR. ZIEMER: So that would be introducing a
 

phrase after “criteria?”
 

DR. DeHART: That’s correct. 

DR. ZIEMER: Maybe there’d be a comma, and
 

then say including? 

DR. DeHART: To include time limits. 

DR. ZIEMER: To include. Time limits? 

DR. DeHART: Yes. The idea of do we wait a 

year or a year and a half, two years.
 

DR. ZIEMER: And does anybody object to that? 

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65 

[No responses]
 

DR. ZIEMER: I think in our discussions there
 

was certainly a concern that there be timely
 

action on these things. No objection? 

MR. GRIFFON: This is Mark Griffon. I’m
 

sorry, not an objection, a comment along the same
 

lines, though. 

I thought at the last meeting we had
 

discussed specific language to be added to a
 

certain section of the preamble, and I didn’t see
 

that in the Attachment 2 either. I didn’t know
 

if we were going to offer specific language, or
 

is this going to be our – I mean, I support this
 

recommendation, but I thought that we had
 

discussed specific language as well.
 

DR. ZIEMER: Specific language on time
 

limits?
 

MR. GRIFFON: No, no, on – I remember a
 

discussion of the criteria that could be used in
 

determining adequacy, such as. And people were
 

talking about radiation measurement record, e.g.,
 

and would give a series of examples. And then we
 

added on a sentence to say NIOSH would further
 

outline these in an operational manual. I
 

thought that was specific language that we had
 

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66 

sort of discussed at the meeting. 

DR. ZIEMER: I apparently didn’t have that if
 

that was the case. Let me – I’m looking into my
 

own notes here now. 

Did anybody else have that? 

MR. GRIFFON: I think this probably covers it
 

anyway. But I did, just as a point of what was
 

discussed last time.
 

DR. DeHART: This is Roy. I remember our
 

talking about it. That’s why I’ve inserted that. 

I don’t remember specifically what Mark was
 

referring to (inaudible). 

MS. MURRAY: This is Marie. I’ve got
 

something here. After Dr. Melius had presented
 

his suggestion, in the discussion following I
 

have are the opinion remains that the point at
 

which the information (inaudible). (inaudible)
 

that is necessary to ensure the fairness of due
 

process and to allow any (inaudible). 

DR. ZIEMER: I don’t have anything more
 

specific myself than this. I think the thing
 

that was inserted here is that the requirement
 

that the guidelines be reviewed by the Board,
 

which means that we have the opportunity at some
 

point then to really take a look at them without
 

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67 

spelling out here what they should be – in other
 

words, not us saying what they are at this point. 

Are you okay on that, Mark?
 

MR. GRIFFON: I think so, yes. I just
 

thought we had – I was looking for it in the
 

(inaudible) Attachment 2, and I didn’t – but
 

this, I think this covers it.
 

DR. ZIEMER: Any other comments?
 

[No responses]
 

DR. ZIEMER: Okay. We appear to have sort of
 

general agreement on that one, so maybe we can
 

move ahead.
 

The last one is Interim Final Rule. And this
 

one raises the same issue that we had on the
 

previous or the second one, and that’s the issue
 

of it being possibly not a consensus viewpoint,
 

the issue of interim final rule. Let me read the
 

paragraph, and then we’ll open it for discussion: 

Some of the Board members recommended that
 

NIOSH issue these regulations as an interim final
 

rule rather than a final rule. The former would
 

allow later modifications to the rule without
 

necessarily going through the full rule making
 

process. Given that some elements of this rule
 

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68 

(e.g., health endangerment criteria, how to
 

handle SEC class members with non-SEC listed
 

cancers, et cetera) have not been fully worked
 

out and will need further development by NIOSH
 

and review by the Board, this may be a prudent
 

approach. If issuing this rule as an interim
 

final rule would inhibit the Secretary of DHHS
 

from certifying new SEC classes, then the Board
 

would recommend that this option not be
 

considered. 

And I think Jim Melius suggested this last
 

sentence in your final draft when I asked you to
 

put that together for us.
 

DR. MELIUS: Yeah. I think if I recall
 

right, Larry raised this as a potential issue
 

with – legal issue. And I wanted to make clear
 

that the full Board, at least the Board people
 

who were left at that time at our meeting, I
 

think we all did not want this to inhibit their
 

ability to be able to (inaudible) - you know, to
 

certify classes.
 

DR. DeHART: This is Roy. My original
 

objection at the time of the meeting is resolved
 

by the last sentence, so I have no objection.
 

MR. PRESLEY: This is Bob Presley. I have –
 

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69 

that’s my feelings exactly, because I feel that
 

the last sentence that’s been added will take all
 

that out.
 

DR. ANDRADE: This is Tony Andrade. I agree,
 

and I move that we adopt it as written.
 

DR. ZIEMER: Okay. Realize that if we – oh,
 

you’re making a motion?
 

DR. ANDRADE: Yes.
 

DR. ZIEMER: On this? 

MR. PRESLEY: This is Bob Presley. If we go
 

back and do that, can we go back and change this
 

then to say that the Board members recommend, and
 

that way we take out “some of the Board?”
 

DR. ZIEMER: Well, keep in mind now, this is
 

the issue of whether – I think some Board members
 

felt on this one that – well, I think there were
 

two views. 

One was that they should go to final rule
 

making. The other was some felt that we
 

shouldn’t get into the issue of whether it was –
 

we’re going to leave it up to the Secretary
 

anyway, so why are we raising this. These are
 

the very issues that NIOSH has to consider. 

After they get all the comments, they have to
 

make the determination what’s in the best
 

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70 

interest of the Agency anyway. So in other
 

words, sort of like do we need to get into this? 

They know what the issues are. But – 

MR. ELLIOTT: Dr. Ziemer, this is Larry
 

Elliott. If I might offer an edit for your
 

consideration to vote on here. It should be, in
 

the first sentence, recommended that HHS issue
 

these regulations. It’s not NIOSH.
 

DR. ZIEMER: Yes.
 

MR. ELLIOTT: It’s actually –
 

DR. ZIEMER: Yeah. If it was approved it
 

would have to say HHS, right.
 

MR. ELLIOTT: We’re just acting here at NIOSH
 

on behalf of the Secretary.
 

DR. ZIEMER: Right, right.
 

DR. DeHART: This is Roy. Going back again
 

to our proceeding when we attempted to get a
 

consensus and were successful, basically that is
 

what my comments are here. This would be a
 

position of the Board, not some members. 

DR. ZIEMER: You’re saying with that final
 

sentence you are okay with this as raising the
 

issue as a Board issue?
 

DR. DeHART: I am.
 

DR. ZIEMER: Why don’t I ask you to make a
 

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71 

motion on that, then, again for this section?
 

DR. DeHART: I will be glad to do that. Roy
 

DeHart making the motion, the Board recommends,
 

with the change of HHS over NIOSH, and continue. 

DR. ZIEMER: Okay. 

MR. PRESLEY: Second it. This is Bob 

Presley. 

DR. ZIEMER: Okay. Discussion? 

The motion, then, would be the Board
 

recommends that these be issued as an interim
 

final rule.
 

MS. MUNN: Well – this is Wanda again. And I
 

guess if we do that then we’re saying that we
 

recommend that it be issued as an interim final
 

rule. And the other members may be more
 

cognizant of what the legal ramifications are
 

that separate an interim final rule and a final
 

rule; I am not. And since I am not familiar with
 

those ramifications, I guess I can’t continue to
 

make that – I can’t say that I’m willing to make
 

that distinction for the Agency.
 

DR. ZIEMER: That’s a good point. Let me
 

offer something. As Chair, I’ll suggest this is
 

a possible – if the mover of the motion would
 

agree to it, this might soften it. Rather than
 

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72 

the Board recommends, that the Board recommends
 

that NIOSH – or that HHS consider issuing.
 

UNIDENTIFIED: I certainly –
 

DR. ZIEMER: That is softer than issuing.
 

DR. DeHART: Yes, I understand. And I
 

certainly accept that, because that’s exactly
 

what they would do in any case.
 

MS. MUNN: Um-hum (affirmative). 

DR. ZIEMER: Right. But it doesn’t – I think
 

it sounds softer.
 

MS. MUNN: Or consider whether these
 

regulations should be issued as an interim final
 

rule.
 

DR. ZIEMER: Which they’re going to do, I
 

suppose, anyway.
 

UNIDENTIFIED: Yes.
 

DR. ZIEMER: But it does get the issue before
 

them without – is that, Roy –
 

DR. DeHART: The mover accepts that.
 

DR. ZIEMER: The mover and the seconder?
 

MR. PRESLEY: The seconder accepts that. 

DR. ZIEMER: The Board recommends that HHS
 

consider issuing these regulations as an interim
 

final rule, and so on.
 

Further discussion? 

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73 

[No responses]
 

DR. ZIEMER: Okay. Are you ready to vote on
 

this item?
 

MS. MUNN: Yes.
 

DR. ZIEMER: Okay. Let’s vote by poll here. 

Cori, do you want to poll the members? 

MS. HOMER: Dr. Andrade?
 

DR. ANDRADE: Yes.
 

MS. HOMER: Dr. DeHart?
 

DR. DeHART: Yes.
 

MS. HOMER: Mr. Espinosa?
 

MR. ESPINOSA: Yes.
 

MS. HOMER: Ms. Gadola?
 

MS. GADOLA: Yes.
 

MS. HOMER: Mr. Griffon?
 

MR. GRIFFON: Yes.
 

MS. HOMER: Dr. Melius?
 

DR. MELIUS: Yes.
 

MS. HOMER: Ms. Munn?
 

MS. MUNN: Yes. 

MS. HOMER: Mr. Presley?
 

MR. PRESLEY: Yes.
 

MS. HOMER: Dr. Ziemer?
 

DR. ZIEMER: Yes.
 

MS. HOMER: It was unanimous.
 

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74 

DR. ZIEMER: Okay. 

DR. MELIUS: This is Jim Melius. I have one
 

procedural. Did we actually formally vote on
 

dose reconstruction guidelines, the previous one? 

I thought we deferred that because there was no –
 

DR. ZIEMER: No, we didn’t. We didn’t vote
 

on it. We only voted on the two where there –
 

we’re going to go back and vote the whole
 

document now.
 

DR. MELIUS: Okay, okay. 

DR. ZIEMER: We by consent agreed to some
 

minor wording changes on dose reconstruction. 

DR. MELIUS: Okay. 

DR. ZIEMER: Everybody understand? On the
 

first one, by consent we had a minor wording
 

thing, the non-SEC listed cancers. On the second
 

one we voted because there was substantial
 

change. The third one we didn’t vote; by
 

consensus we agreed to some minor changes. And
 

the fourth one we voted.
 

Now I will just ask for a motion for approval
 

of –
 

MR. GRIFFON: Can I ask one more question?
 

DR. ZIEMER: Sure.
 

MR. GRIFFON: This is Mark Griffon. As far
 

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75 

as general comments go, I know we had a
 

discussion on the question – and I’m not
 

necessarily even necessarily sure it goes in this
 

document – but the question of assigning dose
 

from an SEC category into the other
 

reconstructible dose, and the response from NIOSH
 

was that that falls under dose reconstruction
 

issues or guidelines. 

And I just wonder where that will be
 

captured, since those rules are final, how the
 

Board could point out that – I guess NIOSH is
 

well aware of it, but how, where that would come
 

up or be clarified by NIOSH.
 

UNIDENTIFIED: Is that in Attachment 2?
 

DR. ZIEMER: Yeah. Mark, I think it was – 

let’s see. 

DR. MELIUS: Was it Attachment 1 under the 

last sentence of non-SEC listed cancers? Does
 

that capture what you’re talking about, Mark? 

Jim Melius.
 

DR. ZIEMER: Yeah, there it is. Address
 

situations where part but not all of a dose
 

history is included in a –
 

MR. GRIFFON: Okay. That’s written to kind
 

of go both ways, I guess, right?
 

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76 

UNIDENTIFIED: Yeah.
 

UNIDENTIFIED: Yeah.
 

MR. GRIFFON: Okay, that’s fine.
 

UNIDENTIFIED: Sort of mislabeled there, but
 

I was trying to, without trying to think of every
 

specific situation, I was trying to get sort of
 

the ways that it would come up. So I think that
 

covers (inaudible). Yeah, thank you. 

DR. ZIEMER: Just for the record now, a
 

motion to approve the general comments as
 

amended?
 

MS. MUNN: Wanda Munn. So move.
 

MR. PRESLEY: Bob Presley. I second this. 

DR. ZIEMER: Any further discussion? 

[No responses]
 

DR. ZIEMER: All in favor say aye.
 

[Ayes respond] 

DR. ZIEMER: Opposed? Oh, wait. Let me ask,
 

any opposed, say no.
 

[No responses]
 

DR. ZIEMER: Any abstentions?
 

[No responses]
 

DR. ZIEMER: We don’t have to poll, then. 

Everybody’s voted in favor.
 

Now, Attachment 2 are the specific comments.
 

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77 

DR. ANDRADE: Paul?
 

DR. ZIEMER: Yes.
 

DR. ANDRADE: This is Tony Andrade.
 

DR. ZIEMER: Yes.
 

DR. ANDRADE: I am unfortunately going to
 

have to leave the phone call. I have a meeting
 

to go to way on the other side of the laboratory. 

However, I would like to just state that on
 

Attachment 2 on all the specific comments that
 

had been proposed, so long as wording changes are
 

very small or insignificant – non-significant,
 

let’s put it that way – I would support them
 

pretty much as written.
 

DR. ZIEMER: Let me also point out that this
 

document was already in our hands at the last
 

meeting, with the exception of one added section
 

which – let’s see, which one was added?
 

UNIDENTIFIED: Section 83.9.
 

DR. ZIEMER: 83.9, which – so the only new
 

thing that is here is 83.9. Everything else was
 

in our hands at the last meeting, and was also
 

distributed publicly. So I’m wondering if we, in
 

the interest of time, if we can forego reading
 

the whole document? Or can we?
 

MS. MUNN: Well, again in the interest of
 

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78 

time before Tony goes away, since 83.9 is the
 

only one that’s really new, perhaps we can ask if
 

there are any substantive comments on that. 

I have one quick one, which –
 

DR. ZIEMER: That would be fine. Then let me
 

have – is that agreeable to everyone? 

[No responses]
 

DR. ZIEMER: Okay, go ahead.
 

MS. MUNN: In the very last sentence under
 

Section 83.9, we refer to the applicant being
 

able to submit a government or other research
 

report. I was a little concerned about the term
 

“other research report.” 

I can imagine anyone being able to say I’m a
 

research firm and I’ve looked at this, and it’s
 

not there. I guess my concern was perhaps
 

slightly more well defined criteria other than
 

just another research report, other than a
 

government report. I don’t know whether that
 

would strike Tony the same way it did me or not,
 

but I was concerned about from whom, under what
 

conditions. I guess I just feel that there ought
 

to be some designation as to source.
 

DR. ZIEMER: I think we’re typically talking
 

about published scientific reports, right?
 

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79 

MS. MUNN: Yes. I think so.
 

UNIDENTIFIED: That’s the way I interpreted
 

it.
 

MS. MUNN: But we didn’t say that. 

UNIDENTIFIED: When I said – 

DR. MELIUS: That would be fine. This is Jim
 

Melius. I wrote that, and that would be –
 

DR. ZIEMER: Can we just add the words
 

“published scientific research report?”
 

UNIDENTIFIED: (inaudible)
 

DR. ANDRADE: I think that would be fine. 

This is Tony Andrade.
 

MS. HOMER: Where do you want that added?
 

UNIDENTIFIED: Other research –
 

DR. ZIEMER: That would be “may submit a
 

government or other published scientific research
 

report.”
 

Now let me ask, in – is it Section 2? 

Attachment 2, Section 83.1, does anyone have any
 

questions or changes? 

MR. PRESLEY: This is Bob Presley. In the
 

last line there, it says we recommend, there’s a
 

spelling problem there. 

DR. ZIEMER: Last line of –
 

MS. MUNN: Of the first paragraph, you have –
 

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80 

it’s a typo.
 

DR. ZIEMER: R-E-C-O – yeah, there’s a seven
 

in there. My magic fingers. I wonder why that
 

didn’t show up as a redline underline here.
 

MS. MUNN: Oh, the computer goofed?
 

DR. ZIEMER: Yeah.
 

UNIDENTIFIED: Thank you, Bob.
 

DR. ANDRADE: Okay, I will have to leave now.
 

DR. ZIEMER: Okay, Tony.
 

MS. MUNN: Thanks, Tony.
 

DR. ANDRADE: Thank you very much. 

DR. ZIEMER: 83.2, any changes? 

MS. MUNN: This is Wanda. I don’t have –
 

again, not substantive changes; it’s just a
 

suggestion with the possibility of rewriting a
 

few words. 

Under the statement, when I re-read that
 

first sentence several times, and finally decided
 

that the reason I was having trouble reading
 

through it is because it seems not to be in the
 

correct chronological order. The statement below
 

it is, but this one is not. 

I suggest that we might change it to say,
 

using the same words, just in a different
 

sequence, a statement addressing our concerns
 

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81 

about individuals who have had a thorough dose
 

reconstruction performed and who have had a claim
 

denied, might appear as item “b” in Section 83.2,
 

et cetera. 

I’m just shifting the –
 

DR. ZIEMER: Yes, Um-hum (affirmative). 

Anyone object to that? That’s just moving
 

the words.
 

UNIDENTIFIED: More logical.
 

DR. ZIEMER: Yes.
 

MR. PRESLEY: This is Bob Presley. It makes
 

it read better.
 

DR. ZIEMER: Okay. 

MS. MUNN: And then I really got tangled up
 

in my underwear while I was trying to read the
 

quote there. I don’t know whether this would
 

help it read better and if I have lost the
 

thought in doing it, but I suggest that we
 

consider:
 

A cancer claimant whose dose reconstruction
 

was completed but whose claim did not qualify for
 

compensation cannot reapply – this is where the
 

change (inaudible) – as a member of a special
 

cohort or use the procedures for designating such
 

classes as a route for appealing a decision. 

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82 

DR. ZIEMER: Could you read that one more
 

time?
 

MS. MUNN: Yes. Everything the same, the
 

first line and the second line up to reapply,
 

starting with reapply, as a member of a special
 

cohort --

DR. ZIEMER: After “reapply?”
 

MS. MUNN: Yes. Reapply as a member of a
 

special cohort, or use the procedures for
 

designating such classes as a route for appealing
 

a decision. 

DR. ZIEMER: Okay. Anyone want to react to
 

that? I’m still looking at it myself.
 

MS. MUNN: I think it means the same thing
 

that it says.
 

DR. ZIEMER: You’re just trying to clarify
 

the language? 

MS. MUNN: Yes.
 

DR. ZIEMER: Cannot reapply as a member of a
 

special cohort or use the procedures for
 

designating classes of employees as members – 

MS. MUNN: Well, I took out the “of employees
 

as members of the special cohort” because it
 

seems to put too many phrases in the line of
 

thinking. 

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83 

DR. ZIEMER: Yeah.
 

MR. KATZ: Dr. Ziemer, it’s Ted Katz here. 

Can I just – I think you’re on treacherous turf
 

here with this rewriting, because then you’re
 

saying that should by one means or another this
 

individual end up in a special exposure cohort
 

they can’t make a claim under the cohort. And of
 

course, this rule can’t do that, but that’s how
 

it would read. 

So say, for example –
 

DR. ZIEMER: I lost my phone contact here for
 

a minute; I’m back on. I probably missed
 

something here.
 

MR. KATZ: Could I repeat that – 

UNIDENTIFIED: Ted, maybe you should repeat
 

that, yeah.
 

MR. KATZ: I’m concerned about this, because
 

this would read, then, to say that say we attempt
 

to do a dose reconstruction, we do a dose
 

reconstruction, they don’t get compensated as a
 

result of that; down the road they’re added to
 

the special exposure cohort. Now I guess that
 

could happen if we found new information that
 

showed that in fact we couldn’t do a dose
 

reconstruction though we had, so we thought we
 

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84 

could down the road, and so we’ve added this
 

class to the cohort that includes this
 

individual. 

This rule would be reading to say that this
 

individual can’t make a claim as a member of the
 

cohort, and of course they could. 

DR. ZIEMER: Yeah, so that’s not the intent.
 

MS. MUNN: No, the intent –
 

MR. KATZ: That’s not the intent, I know. 

It’s just as worded it would say that. 

DR. ZIEMER: Ted, the way it was worded
 

originally, it’s – was that okay, or not?
 

MR. KATZ: I even – 

MS. MUNN: I think it said the same thing. 

MR. KATZ: I still have – I understand the 

intent here. I still have a concern even with
 

the original wording for the same reason, that
 

say we did a dose reconstruction – I know the
 

intent, and I, of course, agree with you that
 

they shouldn’t be using this as an appeal route.
 

DR. ZIEMER: Right.
 

MR. KATZ: But say someone is denied. They
 

have a dose reconstruction, they’re denied. And
 

we come into information down the road that tells
 

us that we in fact couldn’t do a dose
 

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85 

reconstruction for part of their work experience. 

They could be able to apply for a class, a
 

special exposure class, based on that new
 

information. 

So at a minimum I think if you have a
 

statement like this in here, you need – it ought
 

to recognize that the claimant may have obtained
 

information (inaudible) dose reconstruction that
 

calls into question the ability of NIOSH to
 

complete a dose reconstruction for such a class
 

of employees. 

DR. ZIEMER: Right.
 

MR. KATZ: Does that make sense?
 

DR. ZIEMER: Yeah.
 

DR. MELIUS: This is Jim Melius. The other
 

concern I have is that this precludes someone
 

from appealing their dose reconstruction decision
 

on the basis of their – that there wasn’t enough
 

information to complete it with sufficient
 

accuracy.
 

MR. KATZ: I think they would have to make
 

that case in appealing the dose reconstruction. 

UNIDENTIFIED: Correct.
 

DR. MELIUS: And I want them to be able to do
 

it if – I don’t it to be able to preclude them
 

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86 

from doing it in that situation, not as a special
 

cohort appeal, but rather as part of their
 

individual dose reconstruction. 

MR. KATZ: And I didn’t read this as
 

precluding it, but you could always add a
 

sentence to ensure that (inaudible).
 

DR. MELIUS: Well, I’m more worried about
 

when we start messing with this language that
 

we’re going to make –
 

MR. KATZ: Right.
 

MS. MUNN: Well, perhaps we’re trying to say
 

too much. Perhaps we should simply say that a
 

cancer claimant whose dose reconstruction was
 

completed but whose claim did not qualify for
 

compensation cannot use the procedures for
 

designating SEC classes specifically as a route
 

for appealing the decision. 

MR. PRESLEY: Bob Presley. I like that
 

better, because if you leave that “cannot apply”
 

in there that legally can get into some sticky
 

situations. 

DR. ZIEMER: Can you give us that proposed
 

wording again, Wanda, so we can look at it and
 

see how we like that? 

MS. MUNN: I’ll try it.
 

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87 

DR. ZIEMER: Cancer claimant whose dose
 

reconstruction was completely – was completed but
 

whose claim did not qualify for compensation –
 

MS. MUNN: Um-hum (affirmative), cannot –
 

DR. ZIEMER: As a member of a special cohort
 

–
 

MS. MUNN: No, we haven’t said anything about
 

special cohort so far.
 

DR. ZIEMER: Oh, no, no. Right. I got that
 

wrong.
 

MS. MUNN: Did not qualify for compensation
 

cannot use the procedures for designating special
 

cohort classes specifically as a route for
 

appealing a decision. 

UNIDENTIFIED: And how would you determine
 

that? 

DR. ZIEMER: Ted, does that take care of your
 

concerns? 

MR. KATZ: It takes care of the concerns I
 

raised.
 

I guess I would just lay out for you another
 

option. You may not try to – you may choose not
 

to try to solve this with the specific language
 

here, but raise the issue and leave it for HHS
 

lawyers or whoever to figure out what kind –
 

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88 

DR. ZIEMER: Yeah, yeah.
 

MR. KATZ: – of wording, if any, (inaudible)
 

work. But that’s, of course, your decision. 

DR. ZIEMER: You mean instead of trying to do
 

the wording?
 

MR. KATZ: Right. It’s up to you, but I
 

think it’s difficult to sort of on the fly write
 

rule wording. But – 

MS. MUNN: Yeah, well, we’ve discussed it 

long enough. 

DR. MELIUS: Yeah. This is Jim Melius. I
 

think the intent is clear with (inaudible) we use
 

Wanda’s rewording. The defining, the HHS lawyers
 

are going to go through it anyway, so –
 

MS. MUNN: Yeah, they’ll do what they want to
 

do with it.
 

DR. ZIEMER: Wanda, can you read your final
 

wording again, so –
 

MS. MUNN: I can try it. I don’t have it
 

actually written out.
 

A cancer claimant whose dose reconstruction
 

was completed but whose claim did not qualify for
 

compensation cannot use the procedures for
 

designating SEC classes specifically as a route
 

for appealing a decision. 

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89 

DR. ZIEMER: Okay. Everybody get that? 

Would that wording be agreeable to everybody? 

MR. GRIFFON: Can I ask – this is Mark
 

Griffon. Ted Katz a few minutes ago mentioned
 

that we could add a line on to this thing, this
 

does not preclude them from filing an appeal
 

under whatever section it is. And I think that
 

might be an important sentence to add in there,
 

just so that everybody’s clear that there still
 

is an appeal route.
 

MS. MUNN: Yeah, a sentence that says –
 

MR. GRIFFON: Just to clarify –
 

MS. MUNN: – appropriate appeal processes are
 

defined elsewhere. That’s –
 

MR. GRIFFON: It doesn’t add that much, but
 

it just clarifies that –
 

DR. ZIEMER: This does not preclude appeals –
 

MS. MUNN: Under, and the section for the
 

rule, yeah.
 

UNIDENTIFIED: Right.
 

DR. ZIEMER: Where is that? Section what? 

Anybody have that? 

MS. MUNN: I don’t have them all in front of
 

me.
 

MR. KATZ: Just to be clear, I guess, this
 

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90 

would be provisions for contesting case
 

adjudications under the Department of Labor
 

rules.
 

UNIDENTIFIED: Ah, yes.
 

DR. ZIEMER: This does not preclude appeals
 

as set forth in or as provided for?
 

MS. MUNN: Yeah, as provided for elsewhere in 

this rule. 

MR. KATZ: Not this rule. 

DR. ZIEMER: Or in the Department of Labor
 

rules? Is that where it is?
 

MS. MUNN: In existing – 

MR. KATZ: Right, Department of Labor rules
 

for --

MS. MUNN: In existing – 

MR. KATZ: (inaudible) claims.
 

MS. MUNN: – DOL rules.
 

DR. ZIEMER: Okay. A cancer claimant whose
 

dose reconstruction was completed but whose claim
 

did not qualify for compensation cannot use the
 

procedures for designating SEC classes as a route
 

for appealing a decision. This does not preclude
 

appeals as provided for in DOL rules.
 

MS. MUNN: Right.
 

DR. ZIEMER: Is that the wording? 

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91 

MS. MUNN: I think so. I’d approve it.
 

DR. ZIEMER: Just for the record, Wanda, why
 

don’t you move that wording? 

MS. MUNN: I move that wording.
 

DR. MELIUS: Second.
 

DR. ZIEMER: Jim seconded.
 

Further discussion? 

[No responses]
 

DR. ZIEMER: All in favor say aye.
 

[Ayes respond] 

DR. ZIEMER: So now 83.2, as it’s been
 

amended, says: A statement addressing our
 

concerns about individuals who have had a
 

thorough dose reconstruction performed and who
 

have had a claim denied might appear as item “b”
 

in Section 83.2 (requiring that the current item
 

b become item c). This could read as follows. 

And then Wanda’s quote, right?
 

MS. MUNN: Um-hum (affirmative). 

DR. ZIEMER: Good. 

DR. ZIEMER: Any other sections? 

DR. DeHART: This is Roy. Back to 83.9, I 

probably had a senior moment when we were
 

discussing this in Cincinnati, but I thought that
 

what we were talking about was if a scientific
 

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92 

paper discussed dose, even though the DOE
 

couldn’t substantiate it, we would accept that. 

But what we’re saying here is if the scientific
 

paper has no dose history –
 

DR. MELIUS: This is Jim Melius. 

DR. ZIEMER: It could go either way, could it 

not? 

DR. MELIUS: Yeah, but this is how – what the 

people petitioning for SEC class, the applicants,
 

are required to submit, and they’re required to
 

submit one of currently two things. One is some
 

indication that they tried to obtain their dose
 

record and couldn’t, and that’s what most of this
 

refers surely. Second is a report from a health
 

physicist or other dose reconstruction expert
 

that they specifically have gotten involved or
 

whatever in this situation. 

And then we’re adding a third one, which we
 

actually talked about not at the last meeting but
 

the meeting before, and Paul reminded me of it at
 

the last meeting. They also could submit a
 

report, a research report or research paper that
 

indicates there’s not adequate dose information –
 

DR. ZIEMER: Somebody that’s studied that
 

site or whatever.
 

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93 

DR. DeHART: Yes. Okay, so this only applies
 

to what they’re submitting to NIOSH as part of
 

their petition? 

DR. ZIEMER: Meets that requirement. 

DR. DeHART: Yeah. 

DR. ZIEMER: You okay, Roy, on that? 

DR. DeHART: Yeah. For some reason I was 

thinking that if there’s a scientific paper that
 

has dose in it and we can’t find it anywhere
 

else, that’s acceptable. But I understand where
 

you’re going.
 

DR. MELIUS: Yeah. No, it applied to a
 

different situation. And it’s not a senior
 

moment; we didn’t really discuss it at the last
 

meeting – 

[Laughter]
 

DR. MELIUS: – the meeting before. And Paul
 

remembered it; I didn’t. And I had suggested it
 

at the last meeting, so.
 

DR. ZIEMER: Anything else on any of the
 

parts of Attachment 2?
 

MS. MUNN: You have a typo in the first line
 

of Section 83.5. The next to the last word on
 

the first line should be “additional” rather than
 

“addition.”
 

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94 

DR. ZIEMER: You’re right, thank you. 

MS. MUNN: And are we looking at all sections
 

now?
 

DR. ZIEMER: Yeah.
 

MS. MUNN: Section 83.10, I suggested a
 

wording change in this first sentence so that
 

that sentence would read the wording of items
 

blah, blah, blah, and blah.
 

DR. ZIEMER: The wording of – 

MS. MUNN: Of those items.
 

DR. ZIEMER: – instead of – yeah. The
 

wording of. A friendly change. The wording of –
 

MS. MUNN: The wording of all those items
 

infers that the – “infers” rather than “appears”
 

– infers that the Advisory Board is directly
 

involved in processes which – that should say are
 

appropriately HHS (or NIOSH) staff functions. 

It doesn’t change the meaning, but --

DR. ZIEMER: Yeah, that’s good.
 

MS. MUNN: It’s a little more specific. 

DR. ZIEMER: No, I think that’s certainly
 

good editorial change. Any others?
 

MR. GRIFFON: Yeah, Mark Griffon. 83.10,
 

just another question on this. And I’m sure we
 

discussed this at the meeting, but I was so
 

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95 

focused on the broader issues that I probably
 

missed it. 

The question I have on this is not that I
 

think it’s correct that we don’t want to be
 

involved in reviewing all these. If I’m reading
 

this right, this is basically taking the Board’s
 

role out from having to review all the petitions
 

that didn’t meet the first administrative hurdle.
 

DR. ZIEMER: Right, right.
 

MR. GRIFFON: Right. I was wondering, and if
 

we in our quote there, if we can add language to
 

say something to the effect that NIOSH will
 

notify the Board of all petitions which did not
 

meet the administrative requirements identified
 

in, I guess it’s 83.9. 

And my reasoning, before we even get hung up
 

on the language, my reasoning is that I’m just
 

concerned about this question of available data,
 

available information. And if we’re finding – it
 

might be useful for the Board to track and see if
 

there’s a lot of petitions that are coming out
 

that can’t even meet those hurdles of finding
 

whether the data was available or not. I think
 

we might have to look into that further. 

It’s been an issue with us from the beginning
 

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96 

of this Board that access to the data, access to
 

the information from DOE, we need to keep an eye
 

on that. And I’m not suggesting that we review
 

those, but just that we track those to see
 

numbers, to see – and then maybe in the future
 

there may be recommendations there that in
 

certain –
 

DR. ZIEMER: I think it’s our – well, let’s
 

see.
 

MS. MUNN: Is it not our prerogative to do
 

that – this is Wanda – whether or not there are
 

wordings in the rule making?
 

DR. ZIEMER: I think it’s already included. 

If the petition fails to meet a requirement,
 

HHS notifies the petitioner. That’s 83.10,
 

paragraph (b)(2). Paragraph (b)(3) says HHS will
 

report the recommended finding and its basis to
 

the Board. 

So they’re already required to report to the
 

Board on those, as I read it.
 

MR. GRIFFON: Okay. You’re just taking out
 

the review capacity – okay, I –
 

DR. ZIEMER: Yeah, that we have to review it. 

I think they still have to report it, as I
 

understand it. 

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97 

Ted, are you still on the line? Or Greg, can
 

you –
 

MR. KATZ: I’m still on the line. And
 

certainly you’re editing those sections, but it’s
 

readily left in that way, that we would report. 

It would no longer be a recommended decision,
 

because if you don’t have any role then it would
 

be just a decision. 

DR. ZIEMER: Yeah. But –
 

MR. KATZ: Reported to you, right.
 

MR. GRIFFON: Okay. I withdraw. I didn’t
 

see that particular line.
 

DR. ZIEMER: I think the requirements still
 

there. 

MR. GRIFFON: Okay. 

DR. ZIEMER: Any other comments? 

[No responses]
 

DR. ZIEMER: Are you ready to vote on
 

Attachment 2 with the modifications that we’ve
 

already agreed to?
 

MS. MUNN: This is Wanda with one other very
 

minor, very minor editorial.
 

DR. ZIEMER: Oh, okay. That’s fine. Let’s
 

get them all.
 

MS. MUNN: In 83.13, isn’t it a little
 

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98 

plainer to remove the parentheses in sentence one
 

and make a separate sentence out of it, just
 

period at the end of “hearing?”
 

DR. ZIEMER: See, for example, the language?
 

MS. MUNN: Yeah, Um-hum (affirmative). 

DR. ZIEMER: I have no objection. Does that
 

–
 

MS. MUNN: I think it makes reading a little
 

easier.
 

DR. ZIEMER: Anyone object to that? 

MR. PRESLEY: I agree. 

DR. ZIEMER: We’ll just do that as an
 

editorial change. 

Any others?
 

[No responses]
 

DR. ZIEMER: Okay. Motion to approve this
 

Attachment, then?
 

MR. PRESLEY: Bob Presley, I’ll move we
 

approve it.
 

UNIDENTIFIED: Second.
 

DR. ZIEMER: With the changes agreed to.
 

Any further discussion? 

[No responses]
 

DR. ZIEMER: All in favor, say aye.
 

[Ayes respond] 

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99 

DR. ZIEMER: Are there any opposed, say no.
 

[No responses]
 

DR. ZIEMER: None opposed.
 

Any abstention?
 

[No responses]
 

DR. ZIEMER: Maybe we should just – I’m not
 

sure who all is voting at this point. We should
 

take a poll anyway, just because some have left
 

the line.
 

Cori, do you want to go through the list?
 

UNIDENTIFIED: Make sure we have a consensus.
 

DR. ZIEMER: Yeah. 

MS. HOMER: All right. Let’s see, we’ve lost 

Dr. Andrade. 

Dr. DeHart? 

DR. DeHART: Yes. 

MS. HOMER: Mr. Espinosa? 

MR. ESPINOSA: Yes.
 

MS. HOMER: Ms. Gadola?
 

[No response]
 

DR. ZIEMER: Sally not on?
 

[No responses]
 

MS. HOMER: Griffon?
 

MR. GRIFFON: Yes.
 

MS. HOMER: Dr. Melius?
 

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100 

DR. MELIUS: Yes.
 

MS. HOMER: Ms. Munn?
 

MS. MUNN: Yes. 

MS. HOMER: Presley?
 

MR. PRESLEY: Yes.
 

MS. HOMER: Okay. 

DR. ZIEMER: Ziemer, yes.
 

Okay, we have seven yeses. 

MS. HOMER: Yes.
 

DR. ZIEMER: I don’t know if Gen Roessler
 

sent her e-mail to everyone. Do you know if she
 

did?
 

MS. MUNN: I received it.
 

UNIDENTIFIED: I received (inaudible). I
 

think so.
 

DR. ZIEMER: So I think she was generally
 

supportive to the document. 

MS. MUNN: Yes.
 

DR. ZIEMER: So although that doesn’t
 

officially count as a vote, though, as she’s not
 

here at present. 

DR. DeHART: Paul, this is Roy. I’ve got
 

patients rioting in the waiting room.
 

DR. ZIEMER: Okay. I think we have completed
 

our business. Are there any other - any public
 

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101 

comments, other public comments?
 

[No responses]
 

DR. ZIEMER: There appear to be none. If
 

not, I thank everybody for hanging with us
 

through this. I will get the –
 

MS. MURRAY: Excuse me, I’m sorry. This is
 

Marie. May I ask that the text that you all just
 

discussed be e-mailed to Kim and me?
 

DR. ZIEMER: Yes.
 

MS. MURRAY: Thank you.
 

MR. PRESLEY: Is Liz still on here? Liz
 

Homoki?
 

MS. HOMOKI-TITUS: Yes, sir.
 

MR. PRESLEY: This is Bob Presley. Could you
 

call me sometime when you get a chance? I need
 

to ask you a question. 

MS. HOMOKI-TITUS: Yes, I’ll call you.
 

DR. ZIEMER: Cori?
 

MS. HOMER: Yes.
 

DR. ZIEMER: I can e-mail right now what I
 

think – I’ve done a mark-up copy.
 

MS. HOMER: I have as well, so we can compare
 

notes.
 

DR. ZIEMER: Okay. So why don’t – I’ll send
 

mine to Cori, then Cori, can you distribute that?
 

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102 

MS. HOMER: I’ll do so.
 

DR. ZIEMER: I’ll e-mail that here in a
 

couple of seconds, Cori.
 

MS. HOMER: Okay, great. 

MS. GADOLA: Dr. Ziemer? 

DR. ZIEMER: Yes? 

MS. GADOLA: This is Sally. I was having 

some trouble with my phone momentarily, but I was
 

able to hear you all, and I did vote affirmative.
 

DR. ZIEMER: Okay, make sure that’s recorded.
 

Thank you, Sally.
 

MS. GADOLA: You’re welcome.
 

DR. ZIEMER: Okay, if that’s it we’ll declare
 

the meeting adjourned.
 

[Whereupon, the meeting was adjourned at
 

approximately 2:58 p.m.] 

NANCY LEE & ASSOCIATES
 
103 

1 

NANCY LEE & ASSOCIATES
 
 

104 

C E R T I F I C A T E
 

STATE OF GEORGIA )

 )
 

COUNTY OF DEKALB )
 

I, KIM S. NEWSOM, being a Certified Court
 

Reporter in and for the State of Georgia, do hereby
 

certify that the foregoing transcript, consisting of
 

100 pages, was reduced to typewriting by me personally
 

or under my direct supervision, and is a true,
 

complete, and correct transcript of the aforesaid
 

proceedings reported by me.
 

I further certify that I am not related to,
 

employed by, counsel to, or attorney for any parties,
 

attorneys, or counsel involved herein; nor am I
 

financially interested in this matter.
 

This transcript is not deemed to be certified
 

unless this certificate page is dated and signed by
 

me.
 

WITNESS MY HAND AND OFFICIAL SEAL this 16th day of
 

September, 2002.
 

KIM S. NEWSOM, CCR-CVR
 CCR No. B-1642
 

[SEAL]